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Symposium-At-A-Glance
"The Emerging Role of Estrogen-Androgen Therapy in the Care of the Postmenopausal Patient"
The following information is reference material for the August 7 press release entitled, "Adding Androgen to Postmenopausal Estrogen Therapy Can Yield Many Benefits." The Sciwire file name for the related release is ANDROGEN.FH, or the file may be accessed via WWW at http://www.newswise.com/articles/ANDROGEN.FH.html
In adult women, androgens are important for maintaining bone density, well-being and libido. Androgen production, which occurs in the adrenal glands and the ovaries, declines with age, just like estrogen. Although postmenopausal women produce 50 percent less androgen than premenopausal women, the potential benefits of androgen replacement in postmenopausal women have not received the same degree of acceptance as estrogen replacement.
Clinical investigation of oral estrogen-androgen therapy is increasing in response to growing awareness that residual hormonal imbalance persists in some women receiving estrogen-only therapy. The available research strongly suggests that estrogen-androgen replacement can have several important benefits, which were not fully recognized because the health consequences of androgen reduction have not been studied as broadly as estrogen deficiency.
Here is a snapshot of research findings presented at FIGO:
Osteoporosis
∑ In a study where thirty-four postmenopausal women were randomized to estrogen or estrogen-androgen implants and followed for two years, both groups experienced increased bone mass in the spine and hip. However, the estrogen-androgen group experienced significantly greater bone formation (1).
∑ In a large, double-blind, two-year study, estrogen-androgen users experienced a significant increase (3.4 percent) over baseline spinal bone mass density in contrast to no change among women using estrogens alone (2).
∑ In a more recent, open-label study among twenty-eight postmenopausal women randomized to esterified estrogens plus methyltestosterone or conjugated estrogens alone, only the users of combined therapy showed increased bone formation evaluated by biochemical markers of bone metabolism (3)
Sexual Function
∑ Fifty-three oophorectomized women receiving androgen alone or combined estrogen-androgen therapy had higher levels of sexual desire and of arousal during intercourse and more sexual fantasies than those women taking either estrogen alone or placebo (4).
∑ Ovariectomized women of postmenopausal age were found to have lower androgen levels than postmenopausal women with intact ovaries (5, 6).
∑ Controlled clinical studies show that estrogen-androgen replacement can improve sexual drive more effectively than estrogen alone (7).
∑ One study of forty-four oophorectomized and hysterectomized women reported that desire, arousal and number of fantasies, as well as frequency of intercourse and orgasm, were significantly greater among women receiving intramuscular estrogen-androgen injections (8).
Psychological and Affective Functioning
∑ Estrogen-androgen users reported feeling more energetic and composed than users of estrogen alone (9, 10, 11, 12).
∑ Women receiving estrogen or estrogen-androgen intramuscularly each month reported more positive moods than did a placebo group for up to four years following hysterectomy and oophorectomy (13).
Vasomotor Symptoms (hot flashes)
∑ A study of twenty-eight postmenopausal women randomized to esterified estrogens plus methyltestosterone or conjugated estrogen alone showed that estrogen with androgen provided relief from common menopausal symptoms such as hot flashes, sweating, vaginal dryness, fatigue, insomnia, heart palpitations, irritability, nervousness, depression, anxiety and lack of concentration (14).
∑ A study of sixty-six women who had undergone hysterectomy and bilateral oophorectomy found that women taking esterified estrogens plus methyltestosterone had reduced vasomotor symptoms, insomnia and vaginal dryness over a twenty-four month period; similar results were observed in women taking estrogen alone (15).
For additional research and background, see "Estrogen-Androgen for Hormone Replacement: A Review," Rosenberg, et. al., The Journal of Reproductive Medicine, Vol. 42, No.7 , July 1997; and "Androgen and Estrogen-Androgen Hormone Replacement Therapy: A Review of the Safety Literature," 1941-1996, Gelfand et. al., Clinical Therapeutics, Vol. 19, No. 3, 1997.
Specific Reference Citations:
Osteoporosis
(1) Davis SR, McCloud P, Strauss BJG, et al: Testosterone enhances estradiolÃs effects on postmenopausal bone density and sexuality. Maturitas 1995;21:227-236
(2) Watts NB, Notelovitz M, Timmons MC, et al: Comparison of oral estrogens and estrogens plus androgen on bone mineral density, menopausal symptoms, and lipid-lipoprotein profiles in surgical menopausal women. Obstet Gynecol 1995;85:529-537
(3) Raisz LG, Wiita B, Artis A, et al: Comparison of the effects of estrogen alone and estrogen plus androgen on biochemical markers of bone formation and resorption in postmenopausal women. J Clin Endocrinol Metab 1996;81:37-43
Sexual Function
(4) Sherwin BB, Gelfand MM, Brender W: Androgen enhances sexual motivation in females: A prospective, crossover study of sex steroid administration in the surgical menopause. Psychosom Med 1985;47:339-351
(5) Dessypris A, Procope BJ: Plasma testosterone in postmenopausal women (normal and with gynecological diseases) before and after oophorectomy. Effect of ACTH and dexamethasone tests. Acta Endocrinol 1981:Suppl 244:25-27
(6) Vermeulen A: The hormonal activity of the postmenopausal ovary. J Clin Endocrinol Metab 1976;42:247-253
(7) Davis SR, McCloud P, Strauss BJG, Burger H: Testosterone enhances estradiolÃs effects on postmenopausal bone density and sexuality. Maturitas 1995;21:227-236
(8) Sherwin BB, Gelfand MM: The role of androgen in the maintenance of sexual functioning in oophorectomized women. Psychosom Med 1987;49:397-409
Psychological and Affective Functioning
(9) McKeon VA: Hormone replacement therapy: Evaluating the risks and benefits. J Obstet Gynecol Neonate Nurse 1993;23:647-657
(10) Sherwin BB, Gelfand MM: The role of androgen in the maintenance of sexual functioning in oophorectomized women. Psychosom Med 1987;49:397-409
(11) Caldwell BM, Watson RI: An evaluation of psychologic effects of sex hormone administration in aged women: I. Results of therapy after six months. J Gerontol 1952;7:228-244
(12) Sherwin BB: Affective changes with estrogen and androgen replacement therapy in surgically menopausal women. J Affect Disord 1988;14:177-197
Vasomotor Symptoms
(13) Sherwin BB: Affective changes with estrogen and androgen replacement therapy in surgically menopausal women. J Affect Disord 1988;14:177-197
(14) Raisz LG, Wiita B, Artis A, et al: Comparison of the effects of estrogen alone and estrogen plus androgen on biochemical markers of bone formation and resorption in postmenopausal women. J Clin Endocrinol Metab 1996;81:37-43
(15) Watts NB, Notelovitz M, Timmons MC, et al: Comparison of oral estrogens and estrogens plus androgen on bone mineral density, menopausal symptoms, and lipid-lipoprotein profiles in surgical menopausal women. Obstet Gynecol 1995;85:529-537
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