Exogenous androgen treatment in women

There is increasing interest in the use of testosterone as part of postmenopausal hormone replacement therapy, in particular to improve reportedly impaired sexual function (Davis and Tran 2001). Whether the concurrent use of testosterone will impact on the perceived benefits of estrogen hormone replacement therapy on the cardiovascular system is currently unknown. In a 20-year (1975-1994) retrospective survey ofthe Amsterdam Gender Dysphoria Clinic (vanKesteren 1997),293 female-to-male transexuals aged 17-70 years (mean 34) were treated for two months to 41 years (total exposure of 2418 patient-years) with oral testosterone undecanoate 160 mg daily or testosterone (Sustanon) 250 mg i.m. every 2 weeks. There was no excess of cardiovascular (or all cause) mortality or morbidity compared with the general female Dutch population.

In an unmasked study, 40 postmenopausal women on conventional estorgen/ progestin hormone replacement additionally received either placebo or 40 mg testosterone undecoanate per day for eight months. A small but significant increase in the pulsatility index of the middle cerebral artery but not in the internal carotid artery has been seen (Penotti etal. 2001).

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