Clinical review: Controversies regarding transdermal androgen therapy in postmenopausal women.
BACKGROUND
Recently, the field of androgen therapy in postmenopausal women has received much attention and press. Although the ovary ceases to produce follicles and estrogen at menopause, it continues to produce androgens. Hence, many oophorectomized women complain of sexual dysfunction (despite adequate estrogenization). Previous studies of nontransdermal testosterone replacement have shown an improvement in libido and sexual frequency, although at the cost of supraphysiological testosterone levels. Transdermal testosterone patch (Intrinsa) was developed to deliver a physiological amount of testosterone. In 2004, the Food and Drug Administration voted not to approve Intrinsa until long-term safety data are available.


METHODS
Recent trials of Intrinsa in postmenopausal women were included. A MEDLINE search was conducted for articles published over the last 40 yr based on the key words androgen therapy/replacement and postmenopausal women. Relevant placebo-controlled trials of nontransdermal androgen therapy in postmenopausal women were also reviewed.


RESULTS
Early results from industry-funded trials show that transdermal testosterone therapy results in only moderate (although statistically significant) improvement in libido in surgically menopausal women (on estrogen). However, the published data are of short duration (24 wk). Hence, long-term safety in these women remains unclear.


CONCLUSIONS
We recommend a short-term trial (not to exceed 24 wk) of transdermal testosterone therapy (once approved) in surgically menopausal (estrogenized) women with distressful sexual dysfunction. Until the patch gets approval, a short trial of oral methyltestosterone in deserving estrogenized women may be justified.
Basaria
Shehzad
S
Department of Medicine, Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Dobs
Adrian S
AS
D000279:Administration, Cutaneous; D000375:Aging / Q000502:physiology; D000728:Androgens / Q000008:administration & dosage* / Q000097:blood / Q000172:deficiency / Q000502:physiology / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015914:Estrogen Replacement Therapy / Q000379:methods; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008594:Menopause, Premature / Q000502:physiology; D010053:Ovary / Q000502:physiology / Q000601:surgery; D017698:Postmenopause; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy; D019529:Sexuality / Q000187:drug effects; D013739:Testosterone / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
D000728:Androgens; D013739:Testosterone