Comparison of the effects of estrogen alone and estrogen plus androgen on biochemical markers of bone formation and resorption in postmenopausal women.

Abstract

The present study was undertaken to determine whether the addition of an androgen to estrogen therapy in postmenopausal women would alter the skeletal response as determined by measurements of markers of bone formation and resorption. Postmenopausal women were treated for 9 weeks with either a combination of 1.25 mg esterified estrogen and 2.5 mg methyltestosterone (E+A) or 1.25 mg conjugated equine estrogen (CEE). Both groups showed a similar decrease in urinary excretion of the bone resorption markers, deoxypyridinoline, pyridinoline, and hydroxyproline. Patients treated with CEE showed decreases in the serum markers of bone formation, bone-specific alkaline phosphatase, osteocalcin, and C-terminal procollagen peptide. In contrast, subjects treated with E+A showed increases in these markers of bone formation. CEE increased, and E+A decreased serum levels of sex hormone-binding globulin as well as triglycerides and high density lipoprotein levels. Only CEE significantly reduced low density lipoproteins. Both regimens were effective in reducing postmenopausal somatic symptoms, but only E+A had a significant effect on psychological symptoms. We conclude that short term administration of androgen with estrogen may reverse the inhibitory effects of estrogen on bone formation. Long term studies are needed to determine the relative benefits and risks of the combination of estrogen and androgen and whether this results in greater increases in bone mass and strength.

Surgical Menopause

“…[21][22][23][24][25][26] Importantly, testosterone stimulates bone and muscle formation and even small amounts of circulating testosterone seem to have a beneficial protective effect on bone loss and fracture risk. [27][28][29][30][31][32] …”

“…Within 1 to 2 years of surgery, the low levels of estrogen can precipitate vaginal atrophy and dryness, causing dyspareunia and making sexual function bothersome and less frequent. 27,87 By 5 years after premenopausal oophorectomy in BRCA mutation carriers, 54% of patients reported that sexual functioning was compromised. 38 In 2 cross-sectional studies, sexual function in women who had elected to have prophylactic salpingo-oophorectomy was compared with that of women who had chosen screening.…”

Safety of testosterone treatment in postmenopausal women

“…However, as summarized in Table 1, there is no clear-cut dose-response effect noted. This may reflect the means by which the hirsutism is reported (selfreport by the patient vs. observation by the investigator) or the duration of androgen administration, as it often takes 4-6 months of exposure to exogenous T before hirsutism becomes apparent (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). In a randomized, double-blind study of postmenopausal women receiving conjugated equine estrogens (CEEs; 0.625 or 1.25 mg/day) or esterified estrogens (EEs) þ MT (low dose, 0.625 mg EE þ 1.25 mg MT; high dose, 1.25 mg EE þ 2.5 mg MT), facial hair was reported as an adverse event in 3% of women on CEE and in 6% receiving EE þ MT.…”

“…In a subgroup of 100 women in whom facial hair was absent at the start of the study, 14% (29). Table 2 provides the levels of serum or plasma testosterone, free testosterone, and/or bioavailable testosterone achieved with the various doses of MT or the other androgens used to treat women with low libido (23,.…”

Androgens are vital to female sexual health

“…The natural consequence of menopause may be aggravated by the use of hormone replacement therapy [8], which may block whatever steroid hormones the ovaries are still able to produce. Apart from this, oral estrogen therapy stimulates production of the sex hormone-binding globulin, which binds testosterone, thus reducing the free and bioavailable testosterone, reducing its release and reducing target tissue binding.…”