| HORMONE REPLACEMENT THERAPY | PEER-REVIEW
Nevertheless, the
increase in SHBG levels is less evident when oestrogen therapy is administered in the form of subcutaneous implants, permitting testosterone to exert its effects on tissues. This is the rationale behind the use of oestradiol and testosterone in the form of subcutaneous implants for the relief of menopausal symptoms2
. Subdermal implants
The subdermal implants are fabricated in the institution using segments of surgical-grade,
semipermeable
oestradiol annually releases, proportionally, a dose equivalent to that achieved with transdermal patches (50 mg/week), which is considered low-dose. Testosterone implants measure 4 cm in length and
2.4 mm in external diameter, and are filled with 50 mg of 17-beta-testosterone, equivalent to a mean daily release rate of 0.2–0.8 mg/day over 1 year. The implants were inserted using
A set of four
implants of oestradiol annually releases,
proportionally, a dose equivalent to that achieved with
Silastic® tubing (Technical Products, Inc., Decatur, GA, USA), steam-sterilised in an autoclave at 121 °C for 10 minutes and allowed to dry inside the autoclave for a further 10 minutes. Implants are submitted to microbiological and endotoxin control. The oestradiol implants, measuring 5 cm in length and 2.4 mm in external diameter, are filled with 50 mg of 17-beta- oestradiol, providing a release rate that ranges from 4 to 5 mg oestradiol/day over 1 year. A set of four implants of
transdermal patches, which is considered low-dose.
surgical steel trocars in the upper, outer quadrant of the gluteal region of the patients following local anaesthesia with 2% procaine. The most adequate dose of implants
to be used for each individual patient is decided on the basis of her medical history and physical and laboratory examinations.
Side-effects and complications Although doses of several types of medication have been standardised, in a patient on hormonal therapy, changes
in dose may be a result of various factors, including inadequate response and the appearance of minor, undesired side-effects such as mastalgia and cephalea. Individual factors may justify the use of higher doses of oestradiol in hormone therapy regimens, such as the concomitant use of some drugs, including smoking,
prime-journal.com | January/February 2015
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