PEER-REVIEW | HORMONE REPLACEMENT THERAPY | that interact with this steroid and reduce its
bioavailability. Implant site complications were reported by 3.6% of subjects during any of the assessments in clinical trials. Pain was the most frequent implant site complication, reported during and/or after insertion, occurring in 2.9% of subjects. Additionally, haematoma, redness, and swelling were reported by 0.1%, 0.3%, and 0.3% of patients, respectively.
Hormone therapy During menopause, women may experience greater loss of bone mineral density (BMD), mainly in the first 3–4 years, leading to a high risk of fractures and their consequences for patients in this stage of life3
recruited 120 patients from Barcelona, Spain. Using estradiol valerate 4 mg and 200 mg of intramuscular
enanthate of dihydroandrosterone every month, after 1
year they found an increase of 16.9% in TC, 8% in LDL, 6.5% in TG, and reduction of 2.7% in high-density lipoprotein (HDL).
. The relationship between
postmenopause osteoporotic fractures and the decline of ovarian function was previously established. Oestradiol has great importance in the maintenance of bone micro-
The benefits of
hormonal therapy were demonstrated in recent studies through the increase of bone mineral density among users of a oestradiol plus testosterone combination.
architecture, and transdermal forms have high effectiveness in preventing osteoporosis and fractures4–6
. Women in menacme have a natural
protection against cardiovascular diseases. Until the middle of the last decade, hormone therapy was indicated for cardiovascular protection and many observational studies showed a betterment in the lipid profile and reduction in the cardiovascular risk among users of hormonal therapy. Some studies show menopause worsens women’s lipid profiles, the use of oestradiol combined with progesterone has shown worsening of the lipid profile with increase of low-density lipoprotein (LDL)-cholesterol and cardiovascular risk7–12
.
The behaviour of the lipid profile in women using the combination of oestradiol and testosterone is not well defined and the results of the studies are overly controversial13–15
reduction of total cholesterol (TC)13–15
combination. However, a reduction in high-density lipoprotein (HDL) levels was also witnessed. In a study by Castelo-Branco et al16
, androgen therapy
was associated with significant increases in total cholesterol, LDL, and triglycerides (TG). The study
36 ❚ January/February 2015 |
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Benefits to bone density The benefits of hormonal therapy were demonstrated in recent studies through the increase of bone mineral density among users of a oestradiol plus testosterone combination. The use of testosterone seems to further increase the bone mineral density in relation to the isolated use of oestradiol17,18
. Britto et al, studied 61 Brazilian patients in
prospective cohort study using implants of oestradiol and testosterone. BMD assessment through dual energy X-ray absorptiometry showed addition of 1.87% in the lumbar spine and 3.8% in the femur neck BMD in
women using implants, and a decrease in BMD lumbar of 5.92%, and 5.06% in the femur neck, without implants, after 1 year19
.
In a study taken in London with 364 women in post menopause, Garnett et al showed
cm2 control group17
a difference in the digital radiography of 1123 grams of hydroxyapatite (gHa)/ in the group treated with 75 mg of
testosterone versus 0.951 gHa/cm2 .
oestradiol and 100 mg of endodermic in the
neck after 1 year18
Studd et al studied 213 patients using oestradiol implants (75 mg) and testosterone (100 mg) and showed an increase of 8.3% and 2.8% in bone density and lumbar spine and femoral .
Davis et al showed the use of testosterone improved
. A number of studies have presented a when using this
the effects of oestradiol on bone density in a prospective 2 year study of with 34 Australian women in post menopause using implants of 50 mg of oestradiol or oestradiol plus testosterone (50 mg). A bone densitometry (DEXA) was carried out and found an increase of 10% and 8.8% in bone density in the femur and lumbar spine (L1–L4) in the group using oestradiol plus testosterone, compared to 2.4% and 3.5% in the group using isolated oestradiol20
. The favourable oestrogenic
effects on lipids were preserved in women treated with testosterone, in association with beneficial changes in body composition. Savvas et al studied 20 women from London, UK, who
were using long-term oral oestrogen in post-menopause, and inserted implants of oestradiol plus testosterone in
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