domingo, 18 de enero de 2009

Testosterone replacement in postmenopausal women

Comment about the NEJM paper: Testosterone for low libido in postmenopausal women not taking estrogen.

What do we know about the issue?

- Sexual desire is related with testosterone levels in men and women.
- Ovary, in menopausal women, produces less estrogens and androgens.
- In menopausal women dicrease in sexual desire is usual, entity that someone has named: "Hypoactive Sexual Desire Disorder".
- In ooferectomized women (postsurgery menopausal) it has been demonstrated that testosterone replacement improves slightly but with statistical significance the sexual desire and frequency of sexual activity. However the safety profile is unknown in the long term.

A good review about this issue.

What does this article add?

- A randomized controlled trial on 814 menopausal (non-post-surgical) women with no estrogen replacement was performed. Three groups were set up: transdermical patch 300 micrograms per day / 150 micrograms per day and placebo.
- The use of 300 micrograms improves the frequency of sexual relation in women (from 0.7 per month in placebo to 2.1 in treatment group as measured in the 24 week). That difference was statistically significant. It didn't happened with the 150 micrograms group.
- The trial last for a year, during that period some adverse effects was detected: hair grow (23% in placebo and 30% in treatmento group)
- Four breast cancer was diagnosed in the treatment group, none in the placebo's one.
- In conclusion, the replacement with 300 micrograms of testosterone in transdermical patchs improves the frequency of sexual activity (slightly but statistically significant). However the safety profile in the long term is unknown and the treatment could be associated with breast cancer.

What is importante for the family medicine resident about this article?

Sexuallity in menopausal women was a kind of tabu until recent years. However it is important to explora that area as far as affects the quality of life of our patients. We could expect some promotion from pharmaceutical industry related with the use of testosterone in women. We should be able to inform our patients about the real expectations of the treatments and the, until now unkown, potential adverse effects in the long term.

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