Testosterone Patch for Low Sexual Desire in Surgically Menopausal Women: A Randomized Trial

Buster, John E.; Kingsberg, Sheryl A.; Aguirre, Oscar; Brown, Candace; Breaux, Jeffrey; Buch, Akshay; Rodenberg, Cynthia; Wekselman, Kathryn; Casson, Peter R.

doi:10.1097/01.aog.0000158103.27672.0d

Cited by 401 publications

(333 citation statements)

References 31 publications

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“…Many of these studies were performed in women who received concomitant estrogen therapy. [107][108][109][110][111] Safety data are limited; long-term effects of testosterone, including effects on the breast, are unknown. Thus, applicability of testosterone is limited in women who have a history of breast cancer and in women who are unable to receive estrogen therapy.…”

Section: Low Libido and Sexual Dysfunctionmentioning

confidence: 99%

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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). © 2011 Mayo Foundation for Medical Education and ResearchB reast cancer is the leading cause of cancer death in women in the United States who are aged 20 to 59 years. 1 In 2010, an estimated 207,090 new cases of breast cancer were identified in the United States. 2 Although breast cancer risk increases with age, approximately 35% of breast cancers occur during the reproductive and perimenopausal years. 3 The 5-year relative survival rate for women of all ages with breast cancer diagnosed between 1999 and 2005 is 89%. 3 Of the premenopausal breast cancers diagnosed, approximately 58% are both estrogen receptor (ER) and progesterone receptor (PR) positive, 6% are ER positive only, 17% are PR positive only, and 20% are both ER and PR negative. 4 The management and treatment of breast cancer in premenopausal women can affect menstruation, reproduction, and gynecologic health. Breast cancer treatment can have a marked affect on fertility in women who have delayed childbearing and have fewer remaining reproductive years. Among premenopausal women with breast cancer, more than 50% wish to retain their fertility. 5 AUB = abnormal uterine bleeding; E2 = estradiol; EA = endometrial ablation; EC = endometrial cancer; ER = estrogen receptor; FDA = Food and Drug Administration; GnRH = gonadotropin-releasing hormone; IUD = intrauterine device; LNG = levonorgestrel; NSAID = nonsteroidal anti-inflammatory drug; PR = progesterone receptor; SHBG = sex hormone-binding globulin gynecologic issues and conditions are prevalent in reproductive-age women. In the general population, more than 30% of reproductive-age women fulfill criteria for the diagnosis of menorrhagia, 6 25% have symptomatic fibroids, 7 and nearly 67% have an underlying uterine disorder with potential to cause abnormal uterine bleeding (AUB). 8 Among premenopausal women with breast cancer, management of menstrual disorders, contraception, vasomotor symptoms, and fertility presents a challenge. Common and effective hormonal options are less well studied in this population because of significant concern about recurrence of breast cancer. Herein,we present the challenges and discuss management options for young women with breast cancer who present with various common gynecologic conditions.Articles for this review were identified by searching the PubMed database with no date limitations. PREMENoPAUSAL SEx STERoIDS AND THEIR PHARMACoLoGyPhysiologically, premenopausal women with regular cycles have cyclic variation in levels of estradiol (E2) (15-350 pg/ mL [to convert to pmol/L, multiply by 3.671]) and progesterone (0.2-27 ng/mL [to convert to nmol/L, multiply by 3.18]). These "free" (unbound) hormones are biologically active and can enter a target cell and activate its receptor.

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Section: Low Libido and Sexual Dysfunctionmentioning

confidence: 99%

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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“…Experimental data suggest direct effects of testosterone on body composition, lipid levels and glucose metabolism. We postulate that increased androgenicity contributes to the accumulation of visceral fat and impairment of glucose metabolism, creating a vicious circle, whereby the increase in insulin and fat tissue in turn promote the production of 123 Surgical T Transdermal (patch) 300 mg per day 24 weeksBraunstein et al 124 Surgical T Transdermal (patch) 150/300/450 mg per day 24 weeksSimon et al 125 Surgical T Transdermal (patch) 300 mg per day 24 weeksDavis et al 126 Surgical T Transdermal (patch) 300 mg per day 24 weeksShifren et al 120 Natural T Transdermal (patch) 300 mg per day 24 weeksNathorst-Boost et al 127 Natural T Transdermal (gel) 10 mg per day 3 monthsBurger et al 128 Natural/surgical T Implant 50 mg Â 1 6 weeks -Davis et al 122 Natural/surgical T Implant 50 mg per 3 months 24 months k fat mass Farish et al 129 Surgical T Implant 100 mg Â 1 6 monthsHickok et al 130 -MT Oral 1.25 mg per day 6 months k HDL-C Watts et al 131 Surgical MT Oral 2.5 mg per day 24 months k HDL-C, triglycerides Basaria et al 132 Natural/surgical MT Oral 2.5 mg per day 16 weeks k HDL-C, triglycerides m fibrinogen Dobs et al 133 Natural/surgical MT Oral 2.5 mg per day 16 weeks k HDL-C, triglycerides, fat mass Lobo et al 134 Natural/surgical MT Oral 1.25 mg per day 16 weeks k HDL-C, triglycerides Warnock et al 135 Surgical MT Oral 1.25 mg per day 8 weeks k HDL-C, triglycerides Leao et al 136 Surgical MT Oral 1.25 mg per day 12 months k HDL-C m visceral fat mass Barrett-Connor et al 137 Surgical MT Oral 1.25 mg per day 24 months k HDL-C, triglycerides Raisz et al 138 Natural/surgical MT Oral 2.5 mg per day 9 weeks k HDL-C, triglycerides Penotti et al 139 Natural TU Oral 40 mg per day 8 months k HDL-C, m pulsatile index (PI)…”

Section: Discussionmentioning

confidence: 99%

Testosterone, SHBG and cardiovascular health in postmenopausal women

Brand

Schouw

2010

Int J Impot Res

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Cardiovascular disease (CVD) affects men and women differently with women having a lower incidence and later onset of disease. Research has recently refocused interest on the cardiovascular role of androgens. The purpose of this review is to summarize the evidence available on the association between testosterone and cardiovascular health in postmenopausal women. Published studies relating testosterone and sex hormone-binding globulin (SHBG) to CVD and its risk factors were reviewed. Studies included in this review suggest that increased androgenicity, characterized by high testosterone and low SHBG levels, is associated with an adverse CVD risk factor profile in postmenopausal women. However, evidence for an association with cardiovascular events is lacking and it is uncertain whether the observed associations with endogenous testosterone have clinical implications regarding the use of postmenopausal testosterone therapy. Large-scale, longitudinal studies relating testosterone and SHBG levels to cardiovascular risk factors and endpoints are needed to determine the temporal relationship between androgenicity and cardiovascular risk and to ascertain the long-term efficacy and safety of testosterone therapy in postmenopausal women.

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“…Sexual benefit beyond placebo has been demonstrated from 300 mg, but not from 450 mg, transdermal testosterone daily. [73][74][75][76] Benefit was modest and varied across studies, all of which used similar protocols. In most studies, the frequency of 'sexually satisfying events' increased with active drug-from approximately 3, to 5 per month.…”

Section: Systemic Estrogenmentioning

confidence: 99%

Women's sexual function and dysfunction: current uncertainties, future directions

Basson

2008

Int J Impot Res

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There is increasing evidence that women at the outset of sexual activity do not need to have sexual desire, as in 'drive', and that many do not distinguish desire from arousal. Multiple modes of investigation confirm poor correlation between women's subjective arousal and measured genital congestion. Suggested revisions to the DSM-IV definitions of sexual disorder have been published: there is now need to align interview assessments and screening questionnaires with contemporary understanding of women's sexual response. Whereas the psychological factors associated with women's sexual function and resilience to biological insults and external stressors are well documented, the role of biological factors is less clear. Variations in the rate of decline of adrenal and ovarian pro-hormones, activity of converting enzymes in peripheral cells, sensitivity of androgen and estrogen receptors and cerebral production of sex steroids may all be involved. Thus there is great complexity underlying the question of sex hormone supplementation, and in particular, little clarity as to which women have decreased brain and/or peripheral androgen activity. When psychosexual etiological factors appear to be minimal and investigational testosterone supplementation is considered, it would be appropriate to target women with disordered arousal and desire in keeping with the recently recommended revised definitions.

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Testosterone Patch for Low Sexual Desire in Surgically Menopausal Women: A Randomized Trial

Abstract: In surgically menopausal women with hypoactive sexual desire disorder, a 300 mug/d testosterone patch significantly increased satisfying sexual activity and sexual desire, while decreasing personal distress, and was well tolerated through up to 24 weeks of use.

Cited by 401 publications

References 31 publications

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Testosterone, SHBG and cardiovascular health in postmenopausal women

Women's sexual function and dysfunction: current uncertainties, future directions

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