Acute Aortic Dissection in a Postmenopausal Female in the Setting of Parenteral Testosterone, Estradiol, and Progesterone Therapy

Abstract

Objective:The FDA has not approved the use of testosterone in women. However, parenteral testosterone is being used off-label in free standing clinics throughout America. The recent multi-ethnic study of atherosclerosis (MESA) population study showed that postmenopausal women with a higher testosterone/estradiol ratio had a higher incident of cardiovascular disease. This is a case of a postmenopausal woman who dissected her thoracic aorta after 8 months of parenteral testosterone.Methods: The clinical examination, radiographic, and laboratory findings of a patient are presented along with a review of the literature.Results: A heathy postmenopausal women, whose only risk factor was parenteral testosterone, developed a dissection of her entire thoracic aorta.Conclusion: The MESA study and other conflicting publications on cardiovascular events in transgender patients receiving exogenous androgens indicates the need for further investigation to determine the safety of testosterone therapy for women and its possible role in contributing to aortic disease. (AACE Clinical Case Rep. 2019;5:e287-e289) Abbreviations: ED = emergency department; MESA = multi-ethnic study of atherosclerosis

The Role of Testosterone in Hypoactive Sexual Desire in Postmenopausal Women – An Intergrative Review

“…Davis and Braunstein (2012) provide a more reassuring view, citing low rates of cardiovascular events and breast cancer in clinical trials, though they stress the need for more long-term safety data (52). Lastly, Zeihen et al (2019) remark on the limited evidence regarding the overall safety of this therapy (53). These diverse viewpoints underscore the complexity and need for caution in considering testosterone therapy for postmenopausal women, balancing potential benefits with acknowledged risks.…”