Effects of aromatase inhibition on sexual function and well-being in postmenopausal women treated with testosterone: a randomized, placebo-controlled trial

Davis, Susan Ruth; Goldstat, Rebecca; Papalia, Mary-Anne; Shah, Sonal; Kulkarni, Jayashri; Donath, Susan; Bell, Robin Jean

doi:10.1097/01.gme.0000168061.32917.83

Cited by 77 publications

(63 citation statements)

References 27 publications

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“…Blood levels of both testosterone and DHT remained suppressed in women throughout all three hormone conditions in which DISF scores were reduced relative to baseline. Blood testosterone levels were decreased by approximately 30% during Lupron-induced hypogonadism compared with baseline and, therefore, changes in testosterone (or one of its androgen or neurosteroid metabolites) could mediate the observed decline in sexual function and quality of orgasm in women Sherwin et al, 1985;Lobo et al, 2003;Nathorst-Boos et al, 2006;Braunstein et al, 2005;Sherwin and Gelfand, 1987;Shifren et al, 2000;Floter et al, 2002;Davis et al, 2006;Leiblum et al, 2006;Santoro et al, 2005). However, since testosterone was not administered to women in this study, we only can speculate about this possible relationship.…”

Section: Discussionmentioning

confidence: 51%

Pharmacologically Induced Hypogonadism and Sexual Function in Healthy Young Women and Men

Schmidt

Steinberg

Negro

et al. 2008

Neuropsychopharmacol

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Studies fail to find uniform effects of age-related or induced hypogonadism on human sexual function. We examined the effects of induced hypogonadism on sexual function in healthy men and women and attempted to identify predictors of the sexual response to induced hypogonadism or hormone addback. The study design used was a double-blind, controlled, crossover (self-as-own control). The study setting was an ambulatory care clinic in a research hospital, and the participants were 20 men (average ± SD age ¼ 28.5 ± 6.2 years) and 20 women (average ± SD age ¼ 33.5 ± 8.7 years), all healthy and with no history of psychiatric illness. A multidimensional scale assessing several domains of sexual function was the main outcome measure. Participants of the study received depot leuprolide acetate (Lupron) every 4 weeks for 3 months (men) or 5 months (women). After the first month of Lupron alone, men received (in addition to Lupron) testosterone enanthate (200 mg intramuscularly) or placebo every 2 weeks for 1 month each. Women received Lupron alone for 2 months, and then, in addition to Lupron, they received estradiol and progesterone for 5 weeks each. The results of the study: in women, hypogonadism resulted in a significant decrease in global measures of sexual functioning, principally reflecting a significant decrease in the reported quality of orgasm. In men, hypogonadism resulted in significant reductions in all measured domains of sexual function. Testosterone restored sexual functioning scores in men to those seen at baseline, whereas neither estradiol nor progesterone significantly improved the reduced sexual functioning associated with hypogonadism in women. Induced hypogonadism decreased sexual function in a similar number of men and women. No predictors of response were identified except for levels of sexual function at baseline. In conclusion, our data do not support a simple deficiency model for the role of gonadal steroids in human sexual function; moreover, while variable, the role of testosterone in sexual function in men is more apparent than that of estradiol or progesterone in women.

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Section: Discussionmentioning

confidence: 51%

Pharmacologically Induced Hypogonadism and Sexual Function in Healthy Young Women and Men

Schmidt

Steinberg

Negro

et al. 2008

Neuropsychopharmacol

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“…Also, since T binds to SHBG more avidly than does E 2 , it is conceivable that raising the circulating concentrations of androgens would displace E 2 from SHBG. However, as noted above in the transdermal T studies, there was no elevation in either the total or free E 2 levels after T administration compared with the baseline values (36,(38)(39)(40)(41)(42).…”

Section: Breast Cancermentioning

confidence: 63%

“…However, studies have shown that aromatase activity in breast cancer tissue is inversely related to the estrogen status of the womenthose with low serum estrogen concentrations have higher aromatase activity, while women receiving estrogens have lower aromatase activity, which suggests that androgen administration given on a background of concomitant estrogen treatment is unlikely to result in much local biotransformation to estrogens (124)(125)(126)(127)(128). Additionally, in the transdermal T patch and gel studies, the mean serum estradiol level following testosterone administration averaged 104% of the baseline, with a range of 79%-125% in the various studies (34)(35)(36)(38)(39)(40)(41)(42)(43)(44). Following the intramuscular administration of testosterone esters in female-to-male transsexuals, the average serum estradiol level was 99.2% of the baseline, with a range of 96%-113% (56,57).…”

Section: Breast Cancermentioning

confidence: 92%

Safety of testosterone treatment in postmenopausal women

Braunstein¹

2007

Fertility and Sterility

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“…It seems that androgens exhibit a promoting effect on behavior and mood, whereas in elderly women, free testosterone levels correlate inversely to symptoms of depression (108). Physical and cognitive function seem to be improved in postmenopausal women with elevated circulating testosterone levels (107,109,110).…”

Section: Sequelsmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Hyperandrogenism after menopause

Markopoulos

Kassi

Alexandraki

et al. 2015

European Journal of Endocrinology

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Postmenopausal hyperandrogenism is a state of relative or absolute androgen excess originating from either the adrenals and/or the ovaries, clinically manifested as the appearance and/or increase in terminal hair growth or the development of symptoms/signs of virilization. In either settings, physicians need to evaluate such patients and exclude the presence of the relatively rare but potentially life-threatening underlying tumorous causes, particularly adrenal androgen-secreting tumors. It has been suggested that the rapidity of onset along with severity of symptom and the degree of androgen excess followed by relevant imaging studies may suffice to identify the source of excessive androgen secretion. However, up to date, there is no consensus regarding specific clinical and hormonal indices and/or imaging modalities required for diagnostic certainty. This is particularly relevant as the aging population is increasing and more cases of postmenopausal women with clinical/biochemical evidence of hyperandrogenism may become apparent. Furthermore, the long-term sequels of nontumorous hyperandrogenism in postmenopausal women in respect to cardiovascular morbidity and mortality still remain unsettled. This review delineates the etiology and pathophysiology of relative and absolute androgen excess in postmenopausal women. Also, it attempts to unravel distinctive clinical features along with specific hormonal cut-off levels and/or appropriate imaging modalities for the facilitation of the differential diagnosis and the identification of potential long-term sequels.

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Effects of aromatase inhibition on sexual function and well-being in postmenopausal women treated with testosterone: a randomized, placebo-controlled trial

Cited by 77 publications

References 27 publications

Pharmacologically Induced Hypogonadism and Sexual Function in Healthy Young Women and Men

Pharmacologically Induced Hypogonadism and Sexual Function in Healthy Young Women and Men

Safety of testosterone treatment in postmenopausal women

MANAGEMENT OF ENDOCRINE DISEASE: Hyperandrogenism after menopause

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