Mostly testosterone, are produced
by the ovaries
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
drugs 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.
Androgens & Testosterone
Bone Loss From Menopause
Loss of Sexual Interest
Moodiness, Anxiety and Irritability
Increased Skin Changes
Facial Hair Growth
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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
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.
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.
Androgen-estrogen combination therapy has been
shown to increase skin thickness and suppleness. There may also be an associated
increase in oiliness and acne.
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.
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.
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. 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.
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