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Categories available are: Androgens; Estrogens; Progesterone; Bone: Brain; Breast; Cardiovascular; Formulations; Menopausal Symptoms; Premenopause; Progestin; Safety; Uterus.
1. - Bioidentical testosterone cream: a rare cause of postmenopausal virilisation. Ogilvie CM, Levenberg R, Milsom SR.
Aust N Z J Obstet Gynaecol 2009;49(1):116-7
Whether bioidentical or synthetic, hormones are powerful substances and must be dosed appropriately. This is a report of 2 cases of postmenopausal women using 0.1 mg/mL testosterone cream for low libido symptoms. After coming to their doctors with symptoms of virilization, including acne, facial hair, and muscle growth, both women were found to have 20 times the normal level of free testosterone in their blood. Regular testing is essential during any kind of hormone replacement to ensure that normal, physiological levels of a hormone are achieved.
Article on Pubmed
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2. - Safety of maternal testosterone therapy during breast feeding. Glaser RL, Newman M, Parsons M, Zava D, Glaser-Garbrick D.
Int J Pharm Compounding 2009;13(4):314-317.
This was a study of testosterone levels in maternal blood, the infant's blood, and breast milk, after a nursing mother was given testosterone in the form of sublingual drops, vaginal cream, and a pellet implant. None of the delivery methods resulted in a significant increase of testosterone in breast milk or the infant's blood, although levels were raised in the maternal blood showing that the testosterone was absorbed after all 3 delivery methods. The testosterone therapy was effective in relieving symptoms of testosterone deficiency in the mother and was safe for the breast-fed infant.
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3. - Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, Girard G, Baron M, Ayotte N, Moreau M, Dubé R, Côté I, Labrie C, Lavoie L, Berger L, Gilbert L, Martel C, Balser J.
Menopause 2009; 16(5):923-31.
This randomized, placebo-controlled, double-blind clinical trial looked at the effects on libido and sexual function of 3 doses of DHEA or placebo vaginal suppositories applied with an applicator daily at bedtime for 12 weeks in 216 postmenopausal women with vaginal dryness. Potent beneficial effects were seen with all 3 DHEA doses in the 4 aspects of sexual function studied: sensation, lubrication, orgasm, and dryness during intercourse. DHEA converts naturally to active estrogens and Androgens in tissues, and these hormones produced the beneficial effects on sexual function without raising systemic hormone levels.
Article on Pubmed
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4. - Intravaginal dehydroepiandrosterone (Prasterone), a physiological and highly efficient treatment of vaginal atrophy. Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, Girard G, Baron M, Ayotte N, Moreau M, Dubé R, Côté I, Labrie C, Lavoie L, Berger L, Gilbert L, Martel C, Balser J.
Menopause 2009; 16(5):907-22.
This randomized, placebo-controlled, double-blind trial studied the effects of 3 doses of DHEA or placebo given as daily vaginal suppositories for 12 weeks in 216 postmenopausal women with vaginal dryness. The suppositories were inserted at bedtime using an applicator. All measures of vaginal changes (pH, percentage of vaginal parabasal and supeerficial cells, vaginal secretions, and symptoms) showed an improvement after 2 weeks of treatment with all 3 DHEA doses compared to placebo. The cream did not cause serum steroid hormone levels to increase, unlike estrogen formulations applied intravaginally. DHEA converts naturally to active Androgens, such as testosterone, in tissues, and this local conversion is postulated as causing the beneficial effects on vaginal physiology without raising systemic hormone levels.
Article on Pubmed
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5. - Testosterone for low libido in postmenopausal women not using systemic oestrogen therapy. Davis SR.
Med J Aust. 2009; 191(3):134-5.
This editorial, written by the principal investigator for the "Aphrodite" study, concludes that the use of transdermal testosterone for hypoactive sexual desire disorder (HSDD) shows promising results but long-term safety requires further study. The article describes the Aphrodite study, in which 814 women with HSDD were randomized to receive a patch delivering 150 or 300 mcg/day testosterone, or placebo patches, for 52 weeks. The testosterone groups reported significantly more satisfying sexual events and reduction of distress, although the frequency of sexual activity did not increase. Benefits were seen after 8 weeks of therapy. No significant adverse effects were seen.
Article on Pubmed
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6. - The safety of 52 weeks of oral DHEA therapy for postmenopausal women. Panjari M, Bell RJ, Jane F, Adams J, Morrow C, Davis SR.
Maturitas. 2009; 63(3):240-5.
In this study, 93 postmenopausal women received either 50 mg/day DHEA or placebo for 52 weeks. No significant changes, either beneficial or adverse, were seen in the lipid profile (HDL, LDL, total cholesterol and triglycerides), the endometrium, or development of insulin resistance (fasting glucose, fasting insulin, or HOMA-IR).
Article on Pubmed
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7. - The role of testosterone in the management of hypoactive sexual desire disorder in postmenopausal women. Krapf JM, Simon JA.
Maturitas. 2009; 63(3):213-9.
This article reviews testosterone's role in sexual function in women. Research is going on to study the safety and effectiveness of transdermal testosterone therapy in women with low sexual desire, sometimes called HSDD (hypoactive sexual desire disorder) if it leads to distress. The prevalence of this disorder is highest in women who are surgically menopausal, i.e., they have had both ovaries removed, which results in a sudden decline in testosterone levels that leads to a reduced desire for sex and less satisfying sex. The authors review clinical studies of transdermal testosterone therapy, both with and without estrogen, concluding that it is safe and effective in women struggling with HSDD.
Article on Pubmed
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8. - Hormones in wellness and disease prevention: common practices, current state of the evidence, and questions for the future. Schwartz ET, Holtorf K.
Prim Care 2008;35(4):669-705.
This review examines the role of hormones as critical components of overall wellness, and therefore the potential for disease prevention of ensuring that hormone levels are optimal. The authors outline age-related hormone deficiencies and supplementation strategies. The review covers estrogens, progesterone, testosterone, growth hormone and thyroid hormones, covering not only the effects of deficiency and the risk/benefit of supplementation, but also controversies surrounding such treatment. The diagnosis of hormone deficiency and monitoring of treatment is also discussed.
Article on Pubmed
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9. - Is dehydroepiandrosterone a hormone? Labrie F, Luu-The V, Bélanger A, Lin S-X, Simard J, Pelletier G.
J Endocrinol 2005; 187:169-96.
These researchers suggest the use of DHEA for physiological hormone replacement because of its nature as a hormone precursor, producing estrogens and testosterone in the hormone-dependent target tissues precisely according to local needs. It could thus alleviate many of the symptoms of hormone deficiency while avoiding the systemic side effects of too much direct hormone therapy with estrogens or testosterone. They call this new concept "intracrinology" as opposed to endocrinology and suggest that it offers new options for menopausal women.
Article on Pubmed
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10. - Androgens and antiandrogens. Schneider HP.
Ann N Y Acad Sci. 2003;997:292-306.
Article on Pubmed
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11. - Part 3 - The science behind bioidentical hormone replacement therapy. Wepfer ST.
Int J Pharm Compounding 2002;6(2):142-6
Differences between synthetic progestins and bioidentical progesterone in terms of their effects on breast cancer risk, estrogen dominance, and vasomotor symptoms are discussed. The review also covers the use of testosterone for postmenopausal women who have androgen deficiency because of surgically induced menopause. Androgen deficiency is also seen in women receiving estrogen replacement therapy, which reduces bioavailable testosterone because it increases levels of sex hormone binding globulin in the blood. The author concludes that bioidentical hormones are more effective and safer than the synthetic alternatives, but hopes that large trials will soon be conducted to confirm their promising effects.
Link to Abstract
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12. - Androgens in postmenopausal women: production, possible role, and replacement options. Lobo RA.
Obstet Gynecol Surv. 2001;56(6):361-76.
Article on Pubmed
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13. - Safety of estrogen/androgen regimens. Simon JA.
J Reprod Med 2001;46(3 Suppl):281-90.
Article on Pubmed
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14. - Androgen deficiency in women. Miller KK.
J Clin Endocrinol Metab 2001;86(6):2395-401.
Article on Pubmed
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15. - Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge study to a sociobiomedical issue. Baulieu E-E, Thomas G, Legrain S, Lahlou N, Roger M, Debuire B, Faucounau V, Girard L, Hervy M-P, Latour F, Leaud M-C, Mokrane A, Pitti-Ferrandi H, Trivalle C, de Lacharriere O, Nouveau S, Rakoto-Arison B, Souberbielle J-C, Raison J, Le Bouc Y, Raynaud A,
Proc Natl Acad Sci 2000; 97(8):4279-84.
DHEA successfully restored sexual function in older women and had a good safety profile, even after 50 mg/day oral DHEA was administered for one year, in the DHEAge study, which also found an increase in bone mineral density with DHEA treatment in women over 70 years old.
Article on Pubmed
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16. - The therapeutic use of Androgens in women. Davis SR.
J Steroid Biochem Mol Biol. 1999;69(1-6):177-84.
Article on Pubmed
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17. - Dietary supplements of dehydroepiandrosterone in relation to breast cancer risk. Stoll BA.
Eur J Clin Nutr 1999;53(10):771-5.
Article on Pubmed
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18. - Dehydroepiandrosterone replacement in women with adrenal insufficiency. Arlt W, Callies F, Van Vlijmen JC, Koehler I, Reincke M, Bidlingmaier M, Huebler D, Oettel M, Ernst M, Schulte H, Allolio B.
N Eng J Med 1999;341(14):1013-20.
This double-blind crossover study reviewed alternately the effects of 50mg of oral dehydroepiandrosterone (DHEA) daily with placebo in 24 women with adrenal insufficiency. Participants were evaluated using established well-being (depression and anxiety scores) and sexuality (thoughts, interest, satisfaction) scales and serum profiles. Results showed that serum DHEA, DHEA-S and active androgen increased to normal or low-normal levels during treatment. SHBG levels were significantly lower following treatment. IGF-I concentrations increased after treatment (only in women with primary adrenal insufficiency), but IGF-binding protein 3 levels did not change. Serum total and HDL lipoprotein cholesterol levels decreased significantly during treatment. LDL and triglyceride concentrations did not change significantly. Psychological testing scores for well-being and sexuality both improved significantly during treatment. These effects were noticed after treatment for four months, but not after treatment for one month. Authors recommended that treatment with DHEA should be part of hormone replacement therapy for women with adrenal insufficiency.
Article on Pubmed
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19. - Testosterone deficiency: a key factor in the increased cardiovascular risk to women following hysterectomy or with natural aging? Rako S.
J Womens Health 1998;7(7):825-9.
Article on Pubmed
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20. - An alternative method of hormone replacement therapy using the natural sex steroids. Hargrove JT, Osteen KG.
Menopause 1995;6(4):653-674
The authors present a protocol for hormone replacement therapy in postmenopausal women with low levels of estradiol, testosterone, and DHEA. They advocate individualizing therapy for each woman according to her needs, and monitoring blood levels closely. All postmenopausal women are deficient in progesterone, so this should also be given unless contraindicated. Hormones should be replaced only up to the levels found in premenopausal women. Natural hormones are preferable to their synthetic counterparts.
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