Prior
to menopause, androgens, mostly
testosterone, are produced by the ovaries and adrenal glands. Androgens are
important for maintaining bone density and sex drive. After menopause, the
ovaries stop making androgens, the adrenals continue, but the total amount
produced by the body is greatly diminished. Androgens are available combined
with estrogen, for replacement therapy. The only combination drug is ESTRATEST®.
This is prescribed as second-line therapy, for women who have not achieved good
relief from hot flashes or who are complaining of loss of sex drive, on
estrogen.
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Bone
Loss From Menopause:
After menopause, bones loose significant amounts
of calcium. In 25% of women, this bone loss can result in osteoporosis with the
resultant high risk of broken bones. Taking estrogen stops the loss of any more
calcium, but does not replace the calcium already lost. Taking calcium
supplements and vitamin D will not replace the lost calcium, either. There is now
evidence that taking a estrogen-androgen combination can promote new bone
formation.
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Loss
of Sexual Interest:
Loss of interest in sex is a common complaint
of postmenopausal women. Androgens have been shown, in several studies, to
improve libido (sex drive) in postmenopausal women. One study of 136
postmenopausal women complaining of sexual dysfunction were treated initially
with estrogen alone. The estrogen therapy relieved vaginal pain associated with
vaginal dryness, but did little for the loss of sex drive. The women were not
depressed and were in stable marital relationships. When they were given
estrogen-androgen combination therapy 80% reported improved libido.
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Psychological
Well Being:
Between 30% - 70% of postmenopausal women
complain of psychological symptoms such as moodiness, anxiety and irritability.
Higher androgen levels have been associated with better energy levels and an
increased sense of well being.
Skin
Changes:
Androgen-estrogen combination therapy has been
shown to increase skin thickness and suppleness. There may also be an associated
increase in oiliness and acne.
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Virilization and
Hirsuitism:
Virilization is the appearance of masculine
sexual characteristics, such as acne, deepening of the voice, baldness and
increased muscle mass. Hirsuitism is the appearance of facial hair. Some women
on androgens do show some of these symptoms. However, the symptoms are mild and
readily reversible by lowering the dose or stopping the medication. Some studies
have shown that these changes are LESS frequent in estrogen-androgen users.
There is no evidence for an increase in liver disease in women who use
estrogen-androgen therapy. However, women with liver disease should not start
HRT.
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Heart
Disease:
Androgen-estrogen therapy generally decreases
HDL ( good cholesterol ). Estrogen alone increases HDL and this is considered
the reason that estrogen protects from heart disease. Risk factors for heart
disease need to be taken into consideration before starting androgens.
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Final
Conclusion:
Should you be on an estrogen-androgen
combination? Possibly, if 1: You are on estrogen and still experiencing hot
flashes, 2: You are at high risk for osteoporosis and 3: You are on estrogen and
still experiencing loss of sex drive. There are other questions you must answer
with your physician. What is your BMD ? What is your cholesterol HDL ratio?
There are still unanswered questions concerning androgens. How will androgens
impact on heart disease and breast cancer over the long term? More long range
studies are needed. For now take the information you have and discuss it with
your physician if you think you might be a candidate for androgen therapy.
See Hot Flashes
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