Cardiovascular Safety and Benefits of Testosterone Implant Therapy in Postmenopausal Women: Where Are We?

Abstract

We discuss the CV safety and efficacy data for subcutaneous testosterone therapy (STT) in postmenopausal women. We also highlight new directions and applications of correct dosages performed in a specialized center. To recommend STT, we propose innovative criteria (IDEALSTT) according to total testosterone (T) level, carotid artery intima-media thickness, and calculated SCORE for a 10-year risk of fatal cardiovascular disease (CVD). Despite all the controversies, hormone replacement therapy (HRT) with T has gained prominence in treating pre and postmenopausal women in the last decades. HRT with silastic and bioabsorbable testosterone hormone implants has gained prominence recently due to its practicality and effectiveness in treating menopausal symptoms and hypoactive sexual desire disorder. A recent publication on the complications of STT, looking at a large cohort of patients over seven years, demonstrated its long-term safety. However, the cardiovascular (CV) risk and safety of STT in women are still controversial.

The Impact of Menopause on Cardiovascular Aging: A Comprehensive Review of Androgen Influences

“…The optimal dosage, duration, and specific patient populations that may benefit the most from ART are still being investigated. Healthcare providers must engage in shared decision-making with menopausal women, weighing the potential benefits against the potential risks and individual patient characteristics, to make informed decisions regarding the use of ART for cardiovascular health [51,52]. Further research is needed to elucidate the precise mechanisms of androgen action on the cardiovascular system and determine ART's safety and efficacy in menopausal women for cardiovascular health.…”

Clinical Approaches to Nestorone Subdermal Implant Therapy in Women’s Health

“…The administration of hormone implants has been used worldwide for decades and it has increased after the etonogestrel implant (Nexplanon) was disseminated worldwide as an effective and safe contraceptive method [ 15 ]. In some countries, such as Brazil, non-absorbable implants (Silastic) are widely used to treat menopause, contraception, and endometrioses ( Figure 2 ) [ 16 , 17 , 18 , 19 ]. Another peculiarity of this implant is the absence of peaks in serum hormone levels, reducing the possibility of side effects and secondary reactions.…”

“…Sterile Silastic implants are inserted through a 2 mm incision into the subcutaneous tissue of the upper gluteal area or lower abdomen through a small anesthetized incision using a sterile stainless-steel trocar or disposable trocar kit in a simple 5 min procedure [ 16 , 17 , 18 , 19 , 25 ]. After the end of treatment, implants may remain in the patient.…”

“…In addition, there is no consensus among compounding pharmacies, and there is less control of compounded hormones when compared to those available by the pharmaceutical industry. Tests to verify the validity of these implants are practically unfeasible, with possible errors not detected throughout the manufacturing process, exposing the method to criticism and misuse [ 19 , 20 ]. In addition, fixed hormonal doses available in the pharmacy may not suit the majority of patients, thus leading many physicians to opt for compounding pharmacies where there is the opportunity to customize the treatment, as is the case with subcutaneous implants.…”

“…These silastic devices contain hormone molecules inside and are characterized by the programmed release of these hormones, which begins shortly after their subcutaneous insertion until 6 to 12 months. Besides SA implant, several hormones are used commercially through this route, including T, E2, Gestrinone, and Nomegestrol Acetate [ 19 , 20 , 38 ].…”