Effect of methyl testosterone administration on plasma viscosity in postmenopausal women A double-blind, randomized, placebo-controlled trial of the effect of testosterone cream on the sexual motivation of menopausal hysterectomized women with hypoactive sexual desire disorder EFFECT OF OESTROGEN AND TESTOSTERONE IMPLANTS ON PSYCHOLOGICAL DISORDERS IN THE CLIMACTERIC Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on sexual function in postmenopausal women: a randomized controlled trial. Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause. Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder. Testosterone patch for low sexual desire in surgically menopausal women: a randomized trial. Efficacy and safety of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial The effect of transdermal testosterone on mammographic density in postmenopausal women not receiving systemic estrogen therapy. Testosterone therapy increases sexual desire in ageing men with low–normal testosterone levels and symptoms of androgen deficiency Testosterone treatment of HSDD in naturally menopausal women: the ADORE study Testosterone patch for the treatment of hypoactive sexual desire disorder in naturally menopausal women: results from the INTIMATE NM1 Study Effect of androgens combined with hormone therapy on quality of life in post-menopausal women with sexual dysfunction Safety and efficacy of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial. PERCEIVED EFFECTS OF TESTOSTERONE REPLACEMENT THERAPY IN PERIMENOPAUSAL AND POSTMENOPAUSAL WOMEN: AN INTERNET PILOT STUDY Differential symptom response to parenteral estrogen and/or androgen administration in the surgical menopause. Clinically relevant changes in sexual desire, satisfying sexual activity and personal distress as measured by the profile of female sexual function, sexual activity log, and personal distress scale in postmenopausal women with hypoactive sexual desire disorder. Effect of high-dose isoflavones on cognition, quality of life, androgens, and lipoprotein in post-menopausal women Comparative effects of oral esterified estrogens with and without methyltestosterone on endocrine profiles and dimensions of sexual function in postmenopausal women with hypoactive sexual desire. 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Health related quality of life after combined hormone replacement therapy: randomised controlled trial Association of endogenous sex hormones and insulin resistance among postmenopausal women: results from the Postmenopausal Estrogen/Progestin Intervention Trial. A comparative study of the effects of local estrogen with or without local testosterone on vulvovaginal and sexual dysfunction in postmenopausal women. Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial Improved cognitive function in postmenopausal women after 12 weeks of consumption of a soya extract containing isoflavones Treatment with percutanous testosterone gel in postmenopausal women with decreased libido--effects on sexuality and psychological general well-being. Effect of counseling on sexual function and behavior in postmenopausal women and their spouses: a randomized, controlled trial (RCT) study Estrogen and/or androgen replacement therapy and cognitive functioning in surgically menopausal women The Effects of Plasma Estradiol Levels on Increases in Vertebral and Femoral Bone Density Following Therapy With Estradiol and Estradiol With Testosterone Implants Continuous-combined oral estradiol/drospirenone has no detrimental effect on cognitive performance and improves estrogen deficiency symptoms in early postmenopausal women: a randomized placebo-controlled trial
background Coronary heart disease ( CHD ) is the leading cause of mortality in women , with an incidence that increases after menopause , hence suggesting a cardioprotective role of oestrogen . Menopause also results in a decline in and rogen levels with result ing symptoms of decreased libido and sexual dysfunction . Recently , there has been a growing interest in the treatment of postmenopausal women with and rogens . However , no data are available on plasma viscosity and fibrinogen levels in postmenopausal women on combined oestrogen/ and rogen therapy Objectives To assess the safety and efficacy of 10 mg topical testosterone therapy daily ( 2 cm And ro-Feme ® cream ) as a treatment for low sexual desire in postmenopausal hysterectomized women who were already on transdermal estrogen . Methods A double-blind , r and omized , placebo-controlled , cross-over study ( each period being of 3 months ' duration ) was performed in the research center of a tertiary referral women 's hospital . Thirty-six menopausal healthy women were recruited who had undergone a hysterectomy , who were not depressed , were in a stable relationship and who fulfilled diagnostic criteria for low sexual desire , as measured by the Brief Index of Sexual Function for Women ( BISF-W ) . Main outcome measures The primary outcome measure was improvement in the sexuality score as measured by a vali date d tool ( BISF-W ) ; secondary measures were sub-scores of the BISF-W , effect on mood and energy , lipids and testosterone levels .  Results Testosterone cream significantly improved sexual desire , frequency of sex , receptivity and initiation as measured by the BISF-W score . It did not change mood , energy , lipids , blood pressure or weight over the study period . Conclusions Testosterone cream significantly improved sexual scores in menopausal women with low sexual desire . It was effective , easy to use and had no side-effects over the 3-month period of active treatment . It offers a novel and acceptable method of administering testosterone to menopausal women In a double-blind trial oestradiol , oestradiol/testosterone , or placebo implants were assessed for their effects on psychological symptoms in women attending a menopause clinic . After two months , women receiving active treatment scored better than the placebo group on a self-rating scale of distress , on anxiety , and on depression ( p less than 0.05 ) . Postmenopausal but not perimenopausal women improved after placebo , and at 4 months the scores in the three groups no longer differed significantly INTRODUCTION Female libido is multifactorial and complex . Declining estrogen levels in postmenopausal women affects vaginal function . AIM The aim of this study was to evaluate female sexual function after using topical estrogen , testosterone , or polyacrylic acid as vaginal lubricants with K-Y jelly as a placebo lubricant . METHODS This was a r and omized controlled clinical trial on 80 postmenopausal women between 40 and 70 years of age with follow-up at the Menopause Clinic of the CAISM Unicamp . The women were r and omized to treatment with topical vaginal estrogen , testosterone , polyacrylic acid , or oil lubricant alone , three times a week for a period of 12 weeks from November 2011 to January 2013 . MAIN OUTCOME MEASURE We used the Female Sexual Function Index ( FSFI ) to assess changes in sexual response at baseline , and after 6 and 12 weeks . RESULTS After 12 weeks of treatment , polyacrylic acid and topical testosterone produced improvements in the FSFI domains of sexual desire , lubrication , satisfaction , reduced pain during intercourse , and total score compared with lubricant alone . Treatment with topical estrogen in comparison with lubricant alone showed an improvement in the FSFI field of desire . The intragroup analysis over the time of the treatment showed improvements in the fields of desire , lubrication , and reduced pain for polyacrylic acid , testosterone , and estrogen . Furthermore , women who used testosterone showed improvements over time in the fields of arousal , orgasm , and satisfaction . CONCLUSIONS Treatment of postmenopausal women with symptoms of vaginal atrophy with polyacrylic acid , testosterone , and estrogen for 12 weeks produced improvements in self-reported female sexual function when compared with a placebo lubricant & NA ; Various parameters of sexual functioning were assessed in a prospect i ve , crossover investigation of 53 surgically menopausal women . Patients r and omly received either an estrogen‐ and rogen combined preparation , an estrogen‐alone drug , an and rogen‐alone drug , or a placebo .  Also included were a group of women who had undergone hysterectomy and whose ovaries had been left intact . Two treatment phases , each of 3 months ' duration , were separated by an intervening placebo month . Additionally , plasma levels of total estrogens and testosterone were assayed four times during the study concurrent with monitoring of sexual behaviors . It was clear that exogenous and rogen enhanced the intensity of sexual desire and arousal and the frequency of sexual fantasies in hysterectomized and oophorectomized women . However , there was no evidence that testosterone affected physiologic response or interpersonal aspects of sexual behavior . These findings suggest that the major impact of and rogen in women is on sexual motivation and not on sexual activity per se CONTEXT Hypoactive sexual desire disorder ( HSDD ) is one of the most common sexual problems reported by women , but few studies have been conducted to evaluate treatments for this condition . OBJECTIVE The objective of this study was to evaluate the efficacy and safety of a testosterone patch in surgically menopausal women with HSDD . DESIGN The design was a r and omized , double-blind , parallel-group , placebo-controlled , 24-wk study ( the Intimate SM 1 study ) . SETTING The study was performed at private or institutional practice s. PATIENTS The subjects studied were women , aged 26 - 70 yr , with HSDD after bilateral salpingo-oophorectomy who were receiving concomitant estrogen therapy . Placebo ( n = 279 ) or testosterone 300 microg/d ( n = 283 ) was administered . There were 19 patients who withdrew due to adverse events in the placebo group and 24 in the 300 mug/d testosterone group . INTERVENTION Testosterone ( 300 microg/d ) or placebo patches were applied twice weekly . MAIN OUTCOME MEASURE(S ) The primary end point was the change in the frequency of total satisfying sexual activity at 24 wk . Secondary end points included other sexual functioning end points and safety assessment s. RESULTS At 24 wk , there was an increase from baseline in the frequency of total satisfying sexual activity of 2.10 episodes/4 wk in the testosterone group , which was significantly greater than the change of 0.98 episodes/4 wk in the placebo group ( P = 0.0003 ) . The testosterone group also experienced statistically significant improvements in sexual desire and a decrease in distress . The overall safety profile was similar in both treatment groups . CONCLUSION In the Intimate SM 1 study , the testosterone patch improved sexual function and decreased distress in surgically menopausal women with HSDD and was well tolerated in this trial OBJECTIVE To assess the efficacy and safety of a 300 mug/d testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women on concomitant estrogen therapy . METHODS Five hundred thirty-three women with hypoactive sexual desire disorder who had undergone previous hysterectomy and bilateral oophorectomy were enrolled in a 24-week , multicenter , double-blind , placebo-controlled trial . Patients were r and omly assigned to receive placebo or the testosterone patch twice weekly . The primary efficacy endpoint was change from baseline at week 24 in the frequency of total satisfying sexual activity , measured by the Sexual Activity Log . Secondary measures included sexual desire using the Profile of Female Sexual Function and personal distress as measured by the Personal Distress Scale . Hormone levels , adverse events , and clinical laboratory measures were review ed . RESULTS Total satisfying sexual activity significantly improved in the testosterone patch group compared with placebo after 24 weeks ( mean change from baseline , 1.56 compared with 0.73 episodes per 4 weeks , P = .001 ) . Treatment with the testosterone patch also significantly improved sexual desire ( mean change , 10.57 compared with 4.29 , P < .001 ) and decreased personal distress ( P = .009 ) . Serum free , total , and bioavailable testosterone concentrations increased from baseline . Overall , adverse events were similar in both groups ( P > .05 ) . The incidence of and rogenic adverse events was higher in the testosterone group ; most and rogenic adverse events were mild . CONCLUSION 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 Objective : Evaluation of the use of testosterone therapy for hypoactive sexual desire disorder ( HSDD ) after oophorectomy has mostly involved women treated with oral estrogen preparations . We investigated the efficacy and safety of a testosterone patch in surgically menopausal women receiving concurrent transdermal estrogen . Design : Women with HSDD after oophorectomy , for whom this was a concern , who were using transdermal estrogen , were recruited to a 24-week , r and omized , double-blind , placebo-controlled  trial in Europe and Australia . Patients were r and omly allocated to placebo ( n = 40 ) or testosterone 300 & mgr;g/day ( n = 37 ) treatment . Primary endpoints were changes in sexual desire measured by the sexual desire domain of the Profile of Female Sexual Function and the frequency of satisfying sexual activity at 24 weeks . Results : Sixty-one women ( 79 % ) completed the trial . All subjects who received at least one application of study medication were included in analysis . The testosterone-treated group experienced a significantly greater change from baseline in the domain sexual desire score compared with placebo ( change from baseline , 16.43 versus 5.98 ; P = 0.02 ) . The domain scores for arousal , orgasm , decreased sexual concerns , responsiveness , and self-image as well as decreased distress were also significantly greater with testosterone therapy than placebo . The frequency of satisfactory sexual events increased but was not statistically different between treatment groups ( P = 0.06 ) Adverse events occurred with similar frequency in both groups , and no serious risks of therapy were observed Conclusions : In this study , transdermal testosterone therapy via a skin patch improved sexual desire and other sexual function domains . It was well tolerated in these oophorectomized women with HSDD receiving concomitant transdermal estrogen CONTEXT Greater mammographic density is associated with increased breast cancer risk and reduced diagnostic mammographic sensitivity and may be seen with estrogen/progestin therapy ( EPT ) . The effects of testosterone therapy on mammographic density in postmenopausal women not on EPT are not known . OBJECTIVE Our objective was to compare effects of two doses of the testosterone transdermal patch ( TTP ) with placebo in postmenopausal women without concomitant EPT on mammographic density  over 52 wk . DESIGN We conducted a r and omized , double-blind , placebo-controlled , parallel-group , multinational trial . PATIENTS Patients included 279 postmenopausal women participating in a testosterone and sexual function study with paired mammograms for baseline and 52 wk/exit . INTERVENTIONS Patients were r and omized to placebo , TTP 150 microg/d , or TTP 300 microg/d , stratified by menopause type ( natural or surgical ) . MAIN OUTCOME MEASURES Change from baseline to wk 52 in the percentage of dense tissue ( PD ) on digital mammograms . RESULTS A total of 250 women with paired mammograms for study baseline and wk 52 were included in the primary analysis . Mean age was 54.6 yr , baseline body mass index was 27.5 kg/m(2 ) , and 78 % were naturally menopausal . There were no baseline differences between groups . Mean changes from baseline ( + /-SEM ) in PD for placebo , TTP 150 microg/d and TTP 300 microg/d were small ( 0.05 + /- 0.16 , 0.06 + /- 0.19 , and 0.21 + /- 0.17 % ) and not significantly different . There were no statistically significant differences from placebo for total dense or nondense area and no significant relationships between hormone levels and PD after adjustment for body mass index . CONCLUSION TTP therapy over 52 wk appears to have no significant effect on digitally quantified absolute or percent dense mammographic area in postmenopausal women not using EPT Although decline in sexual function is a common reason for ageing men to seek advice regarding testosterone therapy , placebo-controlled trial data have been unable to show a consistent , beneficial role for testosterone . The objective of this study was to determine the effect of testosterone therapy on sexual function in non-obese ageing men with symptoms of and rogen deficiency and low – normal serum testosterone levels . A total of 60 men aged 55 years or older in good general health with total testosterone ( TT ) levels < 15 nM , and with symptoms suggestive of and rogen deficiency , were r and omized in a double-blinded protocol to transdermal testosterone patches or placebo for 12 months  . Sexual function was assessed using the International Index of Erectile Function at weeks 0 , 26 and 52 . In men receiving testosterone TT levels increased by 30 % ( P=0.01 ) and luteinizing hormone decreased by 50 % ( P<0.001 ) . Relative to placebo , testosterone therapy improved sexual desire ( P=0.04 ) ; however other parameters of sexual function including erectile function were unaffected by the treatment . Ageing men in good general health and with symptoms of and rogen deficiency and low – normal serum testosterone levels receiving 12 months of transdermal testosterone therapy experienced , relative to placebo , improved sexual desire but no effect on other parameters of sexual function Objective To evaluate the efficacy and safety of a transdermal testosterone patch ( TTP , 300 μg/day ) in naturally menopausal women with hypoactive sexual desire disorder ( HSDD ) . Methods A total of 272 naturally menopausal women , predominantly not using hormone therapy , were r and omized in this 6-month , placebo-controlled , double-blind , multicenter study to receive twice weekly either TTP or an identical placebo . Efficacy endpoints measured were the 4-week frequency of satisfying sexual episodes ( SSE ) using the Sexual Activity Log , the sexual desire domain of the Profile of Female Sexual Function and distress by the Personal Distress Scale . Safety was assessed by adverse events , laboratory parameters and hormone levels . Results The TTP group demonstrated significant improvements in SSE ( p = 0.0089 ) as well as in sexual desire ( p = 0.0007 ) and reduced personal distress ( p = 0.0024 ) versus placebo at 6 months ( intent-to-treat analysis , n = 247 ) . The results were significant for all three endpoints in the subgroup ( n = 199 ) not using hormone therapy . Similar numbers of women treated with placebo and TTP discontinued ( n = 39 , 27.5 % vs. n = 26 , 20 % ) , reported adverse events ( including application site reactions ) ( n = 101 , 71.1 % vs. n = 81 , 62.3 % ) and withdrew due to adverse events ( n = 20 , 14.1 % vs. n = 9 , 6.9 % ) . No clinical ly relevant changes were noted in laboratory parameters . Serum free and total testosterone levels increased from baseline in the TTP group ( geometric means 5.65 pg/ml and 67.8 ng/dl , respectively , at week 24 ) within the physiological range ; no changes were seen in estradiol and sex hormone binding globulin levels . Conclusions TTP was effective in treating HSDD and improving sexual function in this study of naturally menopausal women with and without concurrent hormone therapy Objective : To evaluate the efficacy and safety of a testosterone patch for the treatment of women with hypoactive sexual desire disorder after natural menopause . Design : A multicenter , r and omized , double-blind , placebo-controlled , parallel-group trial was conducted in naturally menopausal women with hypoactive sexual desire disorder receiving a stable dose of oral estrogen with or without progestin ( N = 549 ) . Women were r and omized to receive testosterone 300 & mgr;g/day or placebo patches twice weekly for 24 weeks . The primary efficacy measure was change from baseline in frequency of total satisfying sexual activity over a 4-week period ( weeks 21 - 24 ) . Results : A total of 483 women ( 88 % ) were included in the primary analysis population ( those with baseline sex hormone binding globulin levels ≤160 nmol/L ) . The change from baseline in number of total satisfying sexual episodes was significantly greater for testosterone compared with placebo ( participants with baseline sex hormone binding globulin levels ≤160 nmol/L , mean change of 2.1 ± 0.28 versus 0.5 ± 0.23 episodes/4 weeks ; P < 0.0001 ; intent-to-treat population , mean change from baseline of 1.9 ± 0.26 versus 0.5 ± 0.21 episodes/4 weeks , P <  0.0001  ) . Testosterone also produced statistically significant improvements  compared with placebo in all secondary efficacy measures , including sexual desire and personal distress . The testosterone patch was well tolerated . Conclusions : Testosterone patch treatment increased the frequency of satisfying sexual activity and sexual desire , decreased personal distress , and was well tolerated in naturally menopausal women with hypoactive sexual desire disorder Aim . To evaluate with vali date d instruments changes in quality of life and sexuality in women receiving hormonal replacement therapy ( AHT ) .  Design . R and omised , double-blind , double-dummy study with two parallel treatment arms . Patients and methods . Forty-seven healthy post-menopausal women , aged 45–64 years , were evaluated using the Female Sexual Function Index ( FSFI ) and the menopause-specific quality of life question naire ( MENQOL ) . Of them , 40 diagnosed with sexual dysfunction were r and omised ( 1:1 ) to receive daily 0.625 mg of conjugated estrogens plus 1.25 mg of methyl-testosterone and 100 mg of micronised progesterone or placebo . After 3 months follow-up , FSFI and MENQOL question naires were administered for a second time . Results . Quality of life was unchanged in the placebo group whereas AHT significantly improved scores of vasomotor , psychological , physical and sexual symptoms . As expected , FSFI was not modified in the placebo group while in AHT group the FSFI score improved significantly . In addition , at the end of the study , 68.7 % of subjects of the AHT group did not fit did not fit the criteria for sexual dysfunction as per the FSFI ( p < 0.0001 ) . Conclusions . Adding methyl-testosterone to hormone therapy  improves quality of life and sexuality in post-menopausal women with sexual dysfunction BACKGROUND Oophorectomy reduces serum testosterone levels . We studied the efficacy and safety of transdermal testosterone in treating hypoactive sexual desire disorder in surgically menopausal women . METHODS A 24-week , r and omized , double-blind , placebo-controlled , parallel-group , multicenter trial was conducted in women ( aged 24 - 70 years ) who developed distressful low sexual desire after bilateral salpingo-oophorectomy and hysterectomy and who were receiving oral estrogen therapy .  Women were r and omized to receive placebo ( n = 119 ) or testosterone patches in dosages of 150 microg/d ( n = 107 ) , 300 microg/d ( n = 110 ) , or 450 microg/d ( n = 111 ) twice weekly for 24 weeks . Sexual desire and frequency of satisfying sexual activity were primary efficacy outcome measures . RESULTS Of the 447 women r and omized , 318 ( 71 % ) completed the trial . Compared with placebo , women receiving the 300-microg/d testosterone patch had significantly greater increases from baseline in sexual desire ( 67 % vs 48 % ; P = .05 ) and in frequency of satisfying sexual activity ( 79 % vs 43 % ; P = .049 ) . The 150-microg/d group showed no evidence of a treatment effect . The 450-microg/d group also was not statistically different from the 300-microg/d or placebo groups . Marginally significant linear dose-response trends were observed for total satisfying sexual activity and sexual desire at 24 weeks ( P = .06 and .06 , respectively ) . Adverse events occurred with similar frequency in both groups ; no serious safety concerns were observed . CONCLUSIONS The 300-microg/d testosterone patch increased sexual desire and frequency of satisfying sexual activity and was well tolerated in women who developed hypoactive sexual desire disorder after surgical menopause Women experience somatic , mood , energy , and libido changes during menopause .  Testosterone replacement therapy is being prescribed in conjunction with estrogen replacement therapy ( ERT ) for these symptoms . Little is known about women ’s perceptions of the benefits and risks of testosterone , so an Internet survey was conducted to elicit women ’s perceptions of the effects on mood , energy , sexuality , and somatic symptoms .  A sample of 61 women primarily from the United States and Canada participated in the survey ; one woman from Germany and one from Sweden also took part in the survey . Participants reported significantly improved sexuality and improved mood and vigor , with a decline in fatigue . Of the 7 somatic complaints assessed , improvements were noted in 5 ( sleep disturbances , hot flashes , night sweats , vaginal dryness , and appetite ) . A prospect i ve clinical trial is needed to confirm these results The investigation of estrogen and /or and rogen administration on physical and psychological symptoms in the surgical menopause was carried out in a prospect i ve , double-blind , crossover design . When patients who received either a combined estrogen- and rogen drug or and rogen alone  were compared with those who received estrogen alone or placebo , energy level , well-being , and appetite were increased ( p less than 0.01 ) . The and rogen-containing preparations also induced lower somatic , psychological , and total scores on the menopausal index . Superior functioning in the and rogen-treated groups occurred in association with higher plasma testosterone levels during the treatment phases ( p less than 0.01 ) . These data suggest that reduced levels of circulating testosterone subsequent to bilateral oophorectomy may play an important role in the development of physical and psychological symptoms that are frequent sequelae of this surgical procedure INTRODUCTION Transdermal testosterone patch ( TTP ) treatment produced statistically significant improvements in a satisfying sexual activity ( SSA ) , sexual desire , and personal distress in postmenopausal women suffering from hypoactive sexual desire disorder ( HSDD ) , but clinical significance of these changes was not determined . AIM To quantify the magnitude of change in three principal outcomes measures determined by HSDD patients as associated with the perception of meaningful benefit with TTP therapy . METHODS The criteria for defining responders were determined using anchoring methodology and receiver operating characteristics analysis to establish minimum important differences ( MIDs ) in a representative sub sample of 132 patients in two r and omized , controlled trials in surgically menopausal women with HSDD ( N = 1,094 ) . Perceived benefit was established based upon the question " Overall , would you say that you experienced a meaningful benefit from the study patches ? " . These data defined responders and established MIDs for changes in sexual desire , SSA , and personal distress . The MIDs were applied to the two trials to establish responder rates in each treatment group . MAIN OUTCOME MEASURES Changes in score that correspond to the MID for sexual desire , SSA , and personal distress , and responder rates in each treatment group based upon these values . RESULTS Increases in frequency of SSA of greater than 1 activity/4 weeks , increases in sexual desire score of > or = 8.9 , and decreases in the personal distress score of > or = 20.0 were identified as threshold improvements best able to differentiate responders and nonresponders . The responder rate was significantly higher ( P < 0.001 ) in the testosterone group vs. placebo for all three outcomes measures ( sexual desire , 50 % vs. 34 % ; SSA , 44 % vs. 30 % ; personal distress , 51 % vs. 39 % ) . CONCLUSIONS Changes in sexual desire , SSA , and personal distress observed with TTP treatment in surgically menopausal women with HSDD were clinical ly significant and were associated with a meaningful treatment benefit Context : Recent interventional studies indicate that post-menopausal hormone replacement therapy is associated with an increased risk of cardiovascular mortality and breast cancer .  Isoflavones , a class of plant estrogens , have structural similarities to estradiol . Hence , isoflavones may exert beneficial estrogenic health effects in postmenopausal women with fewer adverse effects . Objective : To evaluate the effect of high-dose isoflavones on self-reported quality of life ( QOL ) , cognition , lipoproteins and and rogen status in post-menopausal women . Design and subjects : Double-blind , r and omized , placebo-controlled , 12-week trial of 93 healthy , ambulatory , post-menopausal women ( mean age 56 yr ) . The study was conducted at a tertiary care center in the United States . Intervention : Participants were r and omly assigned to receive 20 g of soy protein containing 160 mg of total isoflavones vs taste-matched placebo ( 20 g whole milk protein ) . Both soy and the placebo were provided in the form of a powder to be mixed with beverages . Main outcome measures : QOL was judged by the Menopause-specific Quality of Life ( MENQOL ) question naire while cognitive function was assessed with st and ard instruments . Total , free , and bioavailable testosterone , gonadotropins , SHBG , and fasting lipids were measured . Results : Eighty-four women ( 90 % ) completed the study ( active=38 , placebo=46 ) . There was a significant improvement in all 4 QOL subscales ( vasomotor , psychosexual , physical , and sexual ) among the women taking isoflavones , while no changes were seen in the placebo group . No significant changes in cognition , serum and rogens or plasma lipids were seen within any of the groups . However , at the end of the study , a group-by-time interaction was observed such that total testosterone and HDL levels were significantly lower in the isoflavones compared to placebo groups . Conclusion : High-dose isoflavones is associated with improved QOL among women who have become menopausal recently . Hence , the timing of isoflavone supplementation with regards to the onset of menopause appears to be important . The use of isoflavones , as an alternative to estrogen therapy , may be potentially useful and seemingly safe in this group of women who are looking for relief from menopausal symptoms OBJECTIVE In some women , a decline in sexual interest accompanies a relative and rogen insufficiency after menopause . We sought to characterize the hormonal effects of the combination of oral esterified estrogens and methyltestosterone and to investigate whether this regimen improves hypoactive sexual desire . DESIGN Double-blind r and omized trial . SETTING Healthy volunteers in a multicenter research environment . PATIENT(S ) Postmenopausal women taking estrogen therapy who were experiencing hypoactive sexual desire . INTERVENTION(S ) 4 months of treatment with 0.625 mg of esterified estrogens ( n = 111 ) or the combination of 0.625 mg of esterified estrogens and 1.25 mg of methyltestosterone ( n = 107 ) . MAIN OUTCOME MEASURES Baseline and end-of- study measurements of total and bioavailable testosterone and sex hormone-binding globulin ( SHBG ) , and mean change in level of sexual interest or desire as rated on the Sexual Interest Question naire . RESULT ( S ) Treatment with the combination of esterified estrogens and methyltestosterone significantly increased the concentration of bioavailable testosterone and suppressed SHBG . Scores measuring sexual interest or desire and frequency of desire increased from baseline with combination treatment and were significantly greater than those achieved with esterified estrogens alone . Treatment with the combination was well tolerated . CONCLUSION ( S ) Increased circulating levels of unbound testosterone and suppression of SHBG provide a plausible hormonal explanation for the significantly improved sexual functioning in women receiving the combination of esterified estrogen and methyltestosterone OBJECTIVE The purpose of this study was to investigate the hormonal changes during the menopausal transition in a non- clinical population . METHODS Fifty-nine healthy Norwegian women participated in a five year prospect i ve longitudinal study during the transition from pre- to post-menopause , starting one to four years before menopause , and ending one to four years postmenopausal . None of these women were given hormone replacement therapy ( HRT ) . Blood sample s were collected every 12 months and luteinizing hormone ( LH ) , follicle stimulating hormone ( FSH ) , steroid hormone binding globuline ( SHBG ) , prolactin ( PRL ) , estradiol ( E2 ) , estrone ( E1 ) , testosterone , and rostendione , dehydroepi and rostendione-sulphate ( DHEA-S ) , and thyroid stimulating hormone ( TSH ) were analyzed . RESULTS The serum levels of FSH and LH , E2 and E1 profile essentially confirmed previous data obtained in cross-sectional studies . A continuous increase in serum FSH and LH and a concomitant fall in E2 and E1 were observed in all women before menopause and in the two postmenopausal years . Both and rostendione and testosterone showed a decline three years before menopause . After the menopause , however , there were fluctuations in the testosterone levels . And rostendione correlated positively with both E2 and E1 and testosterone postmenopausally . Body mass index ( BMI ) did correlate with testosterone , but not with and rostendione . BMI correlated negatively with SHBG . No correlation was found between BMI and E2 , E1 , FSH and LH . CONCLUSION This longitudinal prospect i ve study of hormonal changes during the transition from pre- to postmenopause indicates that not only estrogen hormonal changes , but and rogen hormonal changes as well , precedes the menopause by several years Background Adding testosterone to hormonal therapy could improve sexual function and general well-being among women during climacteric . We evaluated the effectiveness of testosterone undecanoate on sexual function in postmenopausal women utilizing the st and ardized question naire FSFI score . Methods Postmenopausal women with sexual complaints and Female Sexual Function Index ( FSFI ) ≤ 26.5 were enrolled in to this r and omized , double-blinded , placebo-controlled trial . Participants were r and omly assigned to 8-week treatment with either oral testosterone undecanoate 40 mg or placebo twice weekly with daily oral estrogen .  The FSFI scores before and after treatment were compared to assess any improvement of sexual function . Results Seventy women were recruited of which each group had 35 participants . The baseline characteristics and baseline FSFI scores were comparable between both groups . After 8 weeks of treatment , the FSFI scores significantly improved in both groups when compared to the baseline but the FSFI scores from the testosterone group were significantly higher than in the placebo group post-treatment ( 28.6 ± 3.6 , 25.3 ± 6.7 , respectively , p = 0.04 ) . There was no difference in adverse effect between the two groups Conclusions The twice weekly addition of testosterone undecanoate to daily oral estrogen was associated with a significant improvement in sexual function  among postmenopausal women than the use of the estrogen alone . Trial registration Clinical Trials.gov Identifier NCT01724658 ( February 17 , 2012 ) BACKGROUND There is increasing use of hormone replacement therapy ( HRT ) by post-menopausal women . Observational epidemiological studies have shown reductions in cardiovascular risk factors in  HRT users in the USA , but no r and omized controlled trials of HRT have been carried out in the primary practice setting . Previous studies of cardiovascular risk factors have shown a variety of responses according to type of progestagen and oral or topical administration . None has examined the effect of route using an identical progestagen . OBJECTIVES Our aim was to establish differences , if any , in alteration in cardiovascular risk factors with HRT in post-menopausal women according to route of administration of HRT , oral , transdermal and implant , using first oestrogen alone then oestrogen plus norethisterone , or testosterone for implant . METHODS Subjects were recruited by letter of invitation to women aged 50 - 65 years from lists in general practice s local to the Charing Cross Hospital Lipid Clinic in West London . Their menopausal status was confirmed and they were r and omized to one of three treatment groups or acted as controls . They attended for three visits ; at baseline , HRT was initiated as oestrogen alone , oral or transdermal . At the 3-month visit , HRT with the progestagen , norethisterone , was given cyclically , continuously or transdermally until the final visit at 6 months . A separate group of women from the menopause clinic at Chelsea and Westminster Hospital were studied on oestrogen implant then on implanted oestrogen and testosterone . The outcome measures studied were the separate effects of the four regimes as compared with controls on lipoproteins , glucose , insulin , fibrinogen , factor VII and E-selectin , together with weight , waist : hip ratio and blood pressure . RESULTS The continuous combined oestrogen-progestagen therapy had similar effects on cardiovascular risk factors as oestrogen with cyclical progestagen . All regimes lowered low-density lipoprotein cholesterol , the oral route being more potent than the parenteral ; the effect of transdermal HRT was similar to the implant . Lp(a ) was reduced only with the oral route . Reductions in factor VII and E-selectin were observed in both the oral and transdermal routes . There was no increase in body mass index , waist : hip ratio , blood pressure or glucose and insulin levels with any of the HRT regimes used . Systolic blood pressure was reduced with the transdermal route . CONCLUSIONS This study supports the evidence that oestrogen-progestagen HRT , both oral and transdermal , although attenuating some of the benefit of oestrogen alone on fibrinogen and high-density lipoprotein , significantly reduces cardiovascular risk factors , which should diminish post-menopausal risk of coronary disease INTRODUCTION Postmenopausal women with hypoactive sexual desire disorder ( HSDD ) experienced statistically significant improvements in the frequency of satisfying sexual activity , sexual desire , and distress with testosterone treatment in phase III trials , but it was not known whether the magnitude of these effects was clinical ly meaningful . The clinical relevance study was design ed to answer this question . AIM To evaluate the clinical relevance of the treatment benefits . METHODS This study involved a representative sample of 132 surgically postmenopausal women with HSDD who were enrolled in two r and omized , placebo-controlled trials ( N = 1094 ) assessing the efficacy and safety of transdermal testosterone treatment ( 300 mcg/day ) for 6 months . At the end of the studies , prior to unblinding , a sample of women ( 12 % ) was interviewed concerning their experiences with the treatment . MAIN OUTCOME MEASURES Women were asked " Overall , would you say that you experienced a meaningful benefit from the study patches ? " Changes in the efficacy end points in the double-blind studies were compared for the women who did and did not experience an overall meaningful benefit . RESULTS Overall , 33 of 64 women ( 52 % ) who received testosterone reported experiencing a meaningful treatment benefit , compared with 21 of 68 women ( 31 % ) who received placebo ( P = 0.025 ) . Among the women who identified themselves as experiencing a meaningful benefit , the mean ( SE ) change from baseline in 4-week frequency of satisfying sexual activity was 4.4 ( 0.76 ) , in desire score was 21.0 ( 2.78 ) , moving from " seldom " to " sometimes " feeling sexual desire , and in distress score was -36.5 ( 3.96 ) , moving from " often " to " seldom " being distressed . Among the women who identified themselves as not experiencing a meaningful benefit , the mean ( SE ) change from baseline in 4-week frequency of satisfying sexual activity was 0.5 ( 0.31 ) , in desire score was 2.9 ( 1.42 ) , and in distress score was -8.8 ( 2.23 ) . CONCLUSIONS Surgically menopausal women with HSDD in these studies received clinical ly meaningful benefits , including improvements in satisfying sexual activity , sexual desire , and personal distress Sixty-one postmenopausal women were r and omized into 3 groups . Two groups of women were treated with estrogen replacement therapy ( ERT ) by percutaneous administration of estradiol gel at a dosage of 1.25 g and 2.5 g , respectively . The third group of women , receiving no treatment except placebo , was studied concurrently as a control group . Bone mineral density ( BMD ) was measured by quantitative computed tomography ( QCT ) in the vertebrae from T12-L3 and hormones ( E1 , E2 , FSH , LH and testosterone ) were determined by radioimmunoassay at baseline , then at 6 monthly intervals thereafter . One year of the study has been completed thus far . The results of this study indicate that : ( 1 ) loss of BMD in the control group was observed significantly only in surgical menopausal women and no significant loss of BMD was observed in women receiving ERT treatment regimens ; ( 2 ) decrease of E1 in control group and increase of E1 in the treatment group were both significant . These data suggest that percutaneous ERT may be used in prevention of postmenopausal bone loss , particularly in surgical menopausal women and the increased E1 may play a beneficial role in inhibiting loss of bone mass and relieving menopausal syndrome . Different dosages of estradiol gel which did not create any significant difference between the 2 treatment groups , need a longer period of follow-up BACKGROUND The ovaries provide approximately half the circulating testosterone in premenopausal women . After bilateral oophorectomy , many women report impaired sexual functioning despite estrogen replacement . We evaluated the effects of transdermal testosterone in women who had impaired sexual function after surgically induced menopause . METHODS Seventy-five women , 31 to 56 years old , who had undergone oophorectomy and hysterectomy received conjugated equine estrogens ( at least 0.625 mg per day orally ) and , in r and om order , placebo , 150 microg of testosterone , and 300 microg of testosterone per day transdermally for 12 weeks each . Outcome measures included scores on the Brief Index of Sexual Functioning for Women , the Psychological General Well-Being Index , and a sexual-function diary completed over the telephone . RESULTS The mean ( + /-SD ) serum free testosterone concentration increased from 1.2+/-0.8 pg per milliliter ( 4.2+/-2.8 pmol per liter ) during placebo treatment to 3.9+/-2.4 pg per milliliter ( 13.5+/-8.3 pmol per liter ) and 5.9+/-4.8 pg per milliliter ( 20.5+/-16.6 pmol per liter ) during treatment with 150 and 300 microg of testosterone per day , respectively ( normal range , 1.3 to 6.8 pg per milliliter [ 4.5 to 23.6 pmol per liter ] ) . Despite an appreciable placebo response , the higher testosterone dose result ed in further increases in scores for frequency of sexual activity and pleasure-orgasm in the Brief index of Sexual Functioning for Women ( P=0.03 for both comparisons with placebo ) . At the higher dose the percentages of women who had sexual fantasies , masturbated , or engaged in sexual intercourse at least once a week increased two to three times from base line . The positive-well-being , depressed-mood , and composite scores of the Psychological General Well-Being Index also improved at the higher dose ( P=0.04 , P=0.03 , and P=0.04 , respectively , for the comparison with placebo ) , but the scores on the telephone-based diary did not increase significantly . CONCLUSIONS In women who have undergone oophorectomy and hysterectomy , transdermal testosterone improves sexual function and psychological well-being UNLABELLED We studied whether oophorectomy performed after menopause is associated with an increased risk of hip or vertebral fractures in 6295 Study of Osteoporotic Fractures participants . There was no association between postmenopausal oophorectomy and the risk of hip or vertebral fractures . INTRODUCTION Bilateral oophorectomy after natural menopause has been associated with an increased risk of osteoporotic fractures , potentially because of a decline in serum estradiol and testosterone levels after the oophorectomy . We prospect ively tested this hypothesis in the Study of Osteoporotic Fractures ( SOF ) . MATERIAL S AND METHODS We studied 6295 white women 65 years of age participating in the SOF who were not taking estrogen therapy at baseline . Hip fracture analyses included 708 hip fractures ; vertebral fracture analyses included 267 incident vertebral fractures . Baseline serum estradiol and free testosterone values were available in a small subset of participants . RESULTS AND CONCLUSION There were no significant differences in age , weight , or BMD between the women who underwent postmenopausal oophorectomy ( n = 583 ) and those who did not ( n = 5712 ) . Free testosterone levels were significantly lower among women who had a postmenopausal oophorectomy . A history of postmenopausal oophorectomy was not associated with an increased risk of hip ( hazard ratio [ HR ] = 1.1 ; 95 % CI = 0.9 - 1.5 ) or vertebral fracture ( HR = 0.7 ; 95 % CI = 0.5 - 1.2 ) . The relationship between oophorectomy and hip fracture was not altered by adding serum estradiol level ( HR = 1.3 ; 95 % CI = 0.5 - 3.2 ) or serum free testosterone level ( HR = 1.7 ; 95 % CI = 0.8 - 3.7 ) to the model . In summary , postmenopausal oophorectomy was not associated with an increased risk of hip or vertebral fracture in this cohort . These results are in contrast to previous findings , suggesting that the relationship between postmenopausal oophorectomy and fractures is not fully eluci date d and that incidental oophorectomy after menopause should still be considered carefully in each potential patient BACKGROUND The efficacy and safety of testosterone treatment for hypoactive sexual desire disorder in postmenopausal women not receiving estrogen therapy  are unknown . METHODS We conducted a double-blind , placebo-controlled , 52-week trial in which 814 women with hypoactive sexual desire disorder were r and omly assigned to receive a patch delivering 150 or 300 microg of testosterone per day or placebo .  Efficacy was measured to week 24 ; safety was evaluated over a period of 52 weeks , with a subgroup of participants followed for an additional year . The primary end point was the change from baseline to week 24 in the 4-week frequency of satisfying sexual episodes . RESULTS At 24 weeks , the increase in the 4-week frequency of satisfying sexual episodes was significantly greater in the group receiving 300 microg of testosterone per day than in the placebo group ( an increase of 2.1 episodes vs. 0.7 , P<0.001 ) but not in the group receiving 150 microg per day ( 1.2 episodes , P=0.11 ) . As compared with placebo , both doses of testosterone were associated with significant increases in desire ( 300 microg per day , P<0.001 ; 150 microg per day , P=0.04 ) and decreases in distress ( 300 microg per day , P<0.001 ; 150 microg per day , P=0.04 ) . The rate of and rogenic adverse events - primarily unwanted hair growth - was higher in the group receiving 300 microg of testosterone per day than in the placebo group ( 30.0 % vs. 23.1 % ) . Breast cancer was diagnosed in four women who received testosterone ( as compared with none who received placebo ) ; one of the four received the diagnosis in the first 4 months of the study period , and one , in retrospect , had symptoms before undergoing r and omization . CONCLUSIONS In postmenopausal women not receiving estrogen therapy  , treatment with a patch delivering 300 microg of testosterone per day result ed in a modest but meaningful improvement in sexual function . The long-term effects of testosterone , including effects on the breast , remain uncertain . ( Clinical Trials.gov number , NCT00131495 . Objective : Vaginal atrophy is a common chronic condition among postmenopausal women that can affect their quality of life . Recent studies have evaluated new treatment alternatives for vaginal atrophy ; however , few therapeutic options have been thoroughly evaluated . This study aim ed to compare the effectiveness and adverse effects of estrogen , testosterone , polyacrylic acid , and placebo lubricant for the treatment of postmenopausal women with vaginal atrophy . Methods : We conducted a r and omized clinical trial with 80 postmenopausal women aged between 40 and 70 years who were being followed up at the Menopause Clinic of CAISM UNICAMP between November 2011 and January 2013 . Women were r and omly assigned to topical vaginal treatment with estrogen , testosterone , polyacrylic acid , and placebo lubricant , three times a week for 12 weeks . We used the vaginal maturation index , pH , vaginal health score , vaginal flora , laboratory tests , and ultrasound to evaluate changes of vaginal atrophy at baseline and after 6 and 12 weeks of treatment . Results : After a 12-week treatment with topical estrogen and testosterone compared with the lubricant , an increased percentage of participants had vaginal pH less than 5 , increased vaginal score , and an increase in the number of lactobacilli . Treatment with topical estrogen improved the vaginal maturation index and showed increased levels of estradiol in three women . No changes were observed in the endometrial evaluation of all treatment groups . Conclusions : After a 12-week treatment with testosterone and estrogen compared with placebo lubrication , there was a significant improvement in vaginal trophism in postmenopausal women with vaginal atrophy Visceral fat ( VF ) increases with the menopause and is an independent predictor of the metabolic syndrome , diabetes , and cardiovascular disease ( CVD ) in women . Little is known about how hormonal changes during the menopausal transition are related to the increase in VF . We aim ed to determine the relationship between bioavailable testosterone and VF in middle-aged women at various stages of the menopausal transition and whether this relationship is independent of age and other CVD risk factors . The Study of Women 's Health Across the Nation ( SWAN ) is a longitudinal , community-based study . This report uses baseline data from a population -based longitudinal ancillary study at the Chicago site to examine the cross-sectional relationship between testosterone and computed tomography (CT)-assessed VF  in women at different stages of the menopausal transition . Included are 359 women ( 47.2 % black ) , aged 42 - 60 years , who were r and omly selected from a complete community census in which a 72 % participation rate was achieved . In multivariate models , bioavailable testosterone was associated with VF independent of age , race , percent total body fat , and other cardiovascular risk factors . Bioavailable testosterone was a stronger predictor than estradiol and was interchangeable in its strength of association with sex hormone-binding globulin ( SHBG ) . As bioavailable testosterone was associated with VF even after adjusting for insulin resistance , this suggests that it plays an important role in regional fat distribution . Our findings may have direct implication s in explaining the effect of menopause-related testosterone predominance on VF accumulation and subsequent cardiovascular risk Abstract Symptomatic and rogen deficiency is common in patients taking opioid analgesics , as these drugs potently suppress the hypothalamic – pituitary – gonadal axis . However , the efficacy of testosterone replacement in this setting remains unclear . The objective of this trial was to evaluate the efficacy of testosterone replacement on pain perception and other and rogen-dependent outcomes in men with opioid-induced and rogen deficiency . We conducted a r and omized , double-blind , parallel placebo-controlled trial at an outpatient academic research center . Participants were men aged 18 to 64 years on opioid analgesics for chronic noncancer pain , and total testosterone levels were < 350 ng/dL. Participants were r and omly assigned to 14 weeks of daily transdermal gel that contained 5 g of testosterone or placebo . Primary outcomes were changes in self-reported clinical pain and objective ly assessed pain sensitivity . Sexual function , quality of life , and body composition were also assessed . The mean age was 49 years . The median total and free testosterone levels at baseline were 243 ng/dL and 47 pg/mL and 251 ng/dL and 43 pg/mL in the testosterone and placebo arm , respectively . Of the 84 r and omized participants , 65 had follow-up data on efficacy outcomes . Compared with men assigned to the placebo arm , those assigned to testosterone replacement experienced greater improvements in pressure and mechanical hyperalgesia , sexual desire , and role limitation due to emotional problems . Testosterone administration was also associated with an improvement in body composition . There were no between-group differences in changes in self-reported pain . In conclusion , in men with opioid-induced and rogen deficiency , testosterone administration improved pain sensitivity , sexual desire , body composition , and aspects of quality of life Background Epidemiological studies have suggested that female hormones might play a role in asthma and that menopausal hormone therapy ( MHT or hormone replacement therapy ( HRT ) ) might increase the risk of asthma in postmenopausal women . The only prospect i ve study addressing this issue reports an increase in the risk of developing asthma which was similar for oestrogen alone and oestrogen/progestagen treatment . Methods The association between the use of different types of MHT and the risk of asthma onset in postmenopausal women was investigated prospect ively from 1990 to 2002 by biennial question naires as part of the French E3N cohort study .  Asthma onset was considered to be the time of medical diagnosis of asthma cases occurring during the follow-up of women who were asthma free at baseline . Cox proportional hazards models were used , adjusting for potential confounding factors . Results Among 57 664 women free of asthma at menopause , 569 incident cases of asthma were identified during 495 448 years of follow-up . MHT was related to an increased risk of asthma onset ( HR=1.20 , 95 % CI 0.98 to 1.46 ) among recent users . The increase in risk of asthma onset was only significant among women reporting the use of oestrogen alone ( HR=1.54 , 95 % CI 1.13 to 2.09 ) particularly in never smokers ( HR=1.80 , 95 % CI 1.15 to 2.80 ) and women reporting allergic disease prior to asthma onset ( HR=1.86 , 95 % CI 1.18 to 2.93 ) . A small increase in the risk of asthma onset associated with the use of oestrogen/progestagen was also observed in these subgroups . Conclusion Postmenopausal use of oestrogen alone was associated with an increased rate of newly diagnosed asthma in menopausal women Objective : To compare the effect of esterified estrogens and methyltestosterone versus esterified estrogens alone on diminished sexual interest in surgically menopausal women . Design : This r and omized , double-blind study compared the effect of combined esterified estrogens ( 1.25 mg ) and methyltestosterone ( 2.5 mg ) ( EE/MT ) versus esterified estrogens ( 1.25 mg ) alone ( EE ) for 8 weeks . Several different sexual function question naires were used to measure response to therapy . Changes from baseline in sexual interest/function and hormone levels were evaluated after 4 and 8 weeks of treatment . Results : A total of 102 women were r and omized into the study ; 52 ( age range , 32 - 61 years ) to EE/MT and 50 ( age range , 33 - 62 years ) to EE .  After 8 weeks , significant differences between treatments were not seen in the Changes in Sexual Functioning Question naire ( CSFQ-F-C ) sexual desire/interest subscale score , the primary efficacy variable . In contrast statistically significant between-treatment differences were found for several secondary efficacy variables including Menopausal Sexual Interest Question naire ( MSIQ ) sexual interest/desire score , CSFQ-F-C arousal/erection subscale score and Women 's Health Question naire sexual functioning subscale score . The mean serum concentration of bioavailable and free testosterone significantly increased , approximately doubling between baseline and the end of the study in patients receiving EE/MT , with a significant ( P < 0.001 ) between-treatment difference . The mean serum concentration of sex hormone-binding globulin significantly decreased to less than one third of the pretreatment levels in patients receiving EE/MT ( P < 0.001 ) . Both treatments were well tolerated . Conclusions : The mixed results seen with the different sexual function question naires may be due to the CSFQ-F-C 's lack of specificity for this population . Increased levels of bioavailable and free testosterone paralleled the improved MSIQ item scores . Both the EE and EE/MT treatments were well tolerated In this paper , the association of hormones to vasomotor complaints during the menopausal transition is discussed . Fifty-seven regularly menstruating women without history of hormone replacement therapy ( HRT )  were selected for a longitudinal , prospect i ve study around the menopausal transition . The mean age at the start of the study was 51.3 ( + /-2.0 ) years . At intervals of 12 months all women went through a semi-structured interview and filled in question naires .  Venous blood sample s were collected every 12-month for analyses of estradiol ( E2 ) , testosterone , and rostendione , dehydroepi and rosterone-sulphate ( DHEA-S ) , follicle stimulating hormone ( FSH ) , thyrotropin ( TSH ) , and luteinizing hormone ( LH ) . Vasomotor complaints were tested using questions about hot flushes and bouts of sweating in terms of occurrence , frequency and degree of distress . Forty-six percent of the subjects reported hot flushes and bouts of sweating before menopause , increasing to 67 % during the first year after menopause and 49 % in the second year postmenopause . Low levels of estradiol and high levels of FSH were associated with vasomotor complaints before menopause . During menopause high levels of TSH were related to vasomotor complaints . The first year after menopause , women , who at this point achieved hot flushes , were characterised by high levels of E2 , but declining and low levels of FSH , but increasing . Postmenopausal , high levels of testosterone and DHEA-S seemed to protect against vasomotor symptoms . Our most important finding was , that among women who achieved hot flushes at the first assessment postmenopause , the high and rogen levels was a significant predictor of recovery from hot flushes at the last assessment , 1 year later BACKGROUND Decreased libido is one of several changes in sexual function that are often experienced by female cancer patients .  Transdermal testosterone therapy has been associated with increased libido among estrogen-replete women who report low libido . METHODS In a phase III r and omized , placebo-controlled crossover clinical trial , we evaluated whether transdermal testosterone would increase sexual desire in female cancer survivors . Postmenopausal women with a history of cancer and no current evidence of disease were eligible if they reported a decrease in sexual desire and had a sexual partner . Eligible women were r and omly assigned to receive 2 % testosterone in Vanicream for a testosterone dose of 10 mg daily or placebo Vanicream for 4 weeks and were then crossed over to the opposite treatment for an additional 4 weeks . The primary endpoint was sexual desire or libido , as measured using the desire subscales of the Changes in Sexual Functioning Question naire , as assessed at baseline and at the end of 4 and 8 weeks of treatment . Serum levels of bioavailable testosterone were measured at the same times . All statistical tests were two-sided . RESULTS We enrolled 150 women . Women who were on active testosterone cream had higher serum levels of bioavailable testosterone than women on placebo ( mean change from baseline , testosterone versus placebo , week 4 , 11.57 % versus 0 % , difference = 11.57 % , 95 % confidence interval [ CI ] = 8.49 % to 14.65 % ; week 8 , 10.21 % versus 0.28 % , difference = 9.92 % , 95 % CI = 5.42 % to 14.42 % ; P<.001 for all ) . However , the average intrapatient libido change from baseline to weeks 4 and 8 was similar on both arms . CONCLUSION Increased testosterone level did not translate into improved libido , possibly because women on this study were estrogen depleted Estrogen ( E ) deficiency associated with the menopause is the major cause of bone loss in aging women . However , men also lose significant amounts of bone with age , but they do not have the equivalent of menopause , and serum total testosterone ( T ) and E levels decline only marginally with age in men . Thus , it has been difficult to attribute bone loss in aging men to either T or E deficiency . Here , we show in a population -based , age-stratified sample of 346 men , aged 23 - 90 yr , that serum total T and E ( estradiol plus estrone ) levels decreased over the life span by 30 % and 12 % , respectively , but bioavailable ( or nonsex hormone-binding globulin-bound ) T and E levels decreased by 64 % and 47 % , respectively . In these men and in a parallel cohort of 304 women , aged 21 - 94 yr , serum PTH increased 84 % and 64 % over the life span , and urinary N-telopeptide of type I collagen ( NTx ) excretion , a bone resorption marker , increased 77 % and 80 % between age 50 - 85 yr in the men and women , respectively . By univariate analyses , serum bioavailable T and E levels correlated positively with bone mineral density ( BMD ) at the total body , spine , proximal femur , and distal radius and negatively with urinary NTx excretion in men and women . Urinary NTx excretion was also negatively associated with BMD in both sexes . By multivariate analyses , however , serum bioavailable E level was the consistent independent predictor of BMD in both men and postmenopausal women . Thus , bioavailable E levels decline significantly with age and are important predictors of BMD in men as well as women . These studies suggest that in contrast to traditional belief , age-related bone loss may be the result of E deficiency not just in postmenopausal women , but also in men Background and Objective The highest level of scientific evidence available for each therapy for menopausal symptoms was sought , for example , systematic review s of r and omised controlled trials ( RCTs ) . Results There is reasonable evidence that some symptoms are modified by lifestyle , for example , cessation of smoking , exercise , reduction of alcohol , diet and alleviation of psychosocial stress . No complementary medicine , for example , phytoestrogens , black cohosh , herbal or homeopathic medicines or complementary therapies , for example , acupuncture , yoga , chiropractic manipulation , reflexology or magnetic devices have a greater effect than the usual placebo effect seen in quality blinded RCTs . Some have potential side-effects . So-called ' bioidentical hormones ' have no evidence -base and potential for harm . None of the above therapies have evidence of efficacy and long-term safety . Selective serotonin and noradrenaline re-uptake inhibitors ameliorate vasomotor symptoms and sometimes menopausal depression better than placebo . The most effective therapy for menopausal ( oestrogen ) deficiency symptoms is oestrogen which is the main component of hormone replacement therapies ( HRT ) . Compared with placebo HRT is highly effective in relieving hot flushes , night sweats , dry vagina and dyspareunia . It also improved joint pains , sexuality and sleeplessness and reduced subsequent fractures in RCTs . The increased risk of oral HRT for thromboembolism is small around menopause , for those without thrombotic risk factors , and is not elevated with non-oral routes . Cardiovascular disease may be reduced when HRT is initiated near menopause . Breast cancer risk increases after several years with the use of oral HRT containing progestogens at an annual rate of 8/10 000 ( < 0.1 % ) . No increase in breast cancer risk was seen with oestrogen-only HRT Objective Circulating testosterone in women declines during the late reproductive years such that otherwise healthy women in their 40s have approximately half the testosterone level as women in their 20s . Despite this , research showing the benefits of and rogen replacement has been limited to the postmenopausal years . In view of the known premenopausal physiological decline in testosterone , we have evaluated the efficacy of transdermal testosterone therapy on mood , well-being , and sexual function in eugonadal , premenopausal women presenting with low libido . Design Premenopausal women with low libido participated in a r and omized , placebo-controlled , crossover , efficacy study of testosterone cream ( 10 mg/day ) with two double-blind , 12-week , treatment periods separated by a single-blind , 4-week , washout period . Results Thirty-four women completed the study per protocol , with 31 women ( mean age 39.7 ± 4.2 years ; serum testosterone 1.07 + 0.50 nmol/L ) providing complete data  . Testosterone therapy result ed in statistically significant improvements in the composite scores of the Psychological General Well-Being Index [ + 12.9 ( 95 % CI , + 4.6 to + 21.2 ) , P = 0.003 ] and the Sabbatsberg Sexual Self-Rating Scale [ + 15.7 ( 95 % CI , + 6.5 to + 25.0 ) , P = 0.001 ] compared with placebo . A mean decrease in the Beck Depression Inventory score approached significance [ −2.8 ( 95 % CI , −5.7 to + 0.1 ) , P = 0.06 ] . Mean total testosterone levels during treatment were at the high end of the normal range , and estradiol was unchanged . No adverse effects were reported . Conclusions Testosterone therapy  improves well-being , mood , and sexual function in premenopausal women with low libido and low testosterone . As a substantial number of women experience diminished sexual interest and well-being during their late reproductive years , further research is warranted to evaluate the benefits and safety of longer-term intervention To investigate the role of and rogens in increasing bone density and improving low libido in postmenopausal women , we have studied the long-term effects of estradiol and testosterone implants on bone mineral density and sexuality in a prospect i ve , 2 year , single-blind r and omised trial . Thirty-four postmenopausal volunteers were r and omised to treatment with either estradiol implants 50 mg alone ( E ) or estradiol 50 mg plus testosterone 50 mg ( E&T ) , administered 3-monthly for 2 years . Cyclical oral progestins were taken by those women with an intact uterus . Thirty-two women completed the study .  BMD ( DEXA ) of total body , lumbar vertebrae ( L1-L4 ) and hip area increased significantly in both treatment groups . BMD increased more rapidly in the testosterone treated group at all sites . A substantially greater increase in BMD occurred in the E&T group for total body ( P < 0.008 ) , vertebral L1-L4 ( P < 0.001 ) and trochanteric ( P < 0.005 ) measurements . All sexual parameters ( Sabbatsberg sexual self-rating scale ) improved significantly in both groups . Addition of testosterone result ed in a significantly greater improvement compared to E for sexual activity ( P < 0.03 ) , satisfaction ( P < 0.03 ) , pleasure ( P < 0.01 ) , orgasm ( P < 0.035 ) and relevancy ( P < 0.05 ) . Total cholesterol and LDL-cholesterol fell in both groups as did total body fat . Total body fat-free mass ( DEXA , anthropometry , impedance ) increased in the E&T group only . We concluded that in postmenopausal women , treatment with combined estradiol and testosterone implants was more effective in increasing bone mineral density in the hip and lumbar spine than estradiol implants alone . Significantly greater improvement in sexuality was observed with combined therapy , verifying the therapeutic value of testosterone implants for diminished libido in postmenopausal women . The favourable estrogenic effects on lipids were preserved in women treated with T , in association with beneficial changes in body composition To investigate the role of and rogens in increasing bone density and improving low libido in postmenopausal women , we have studied the long-term effects of estradiol and testosterone implants on bone mineral density and sexuality in a prospect i ve , 2 year , single-blind r and omised trial . Thirty-four postmenopausal volunteers were r and omised to treatment with either estradiol implants 50 mg alone ( E ) or estradiol 50 mg plus testosterone 50 mg ( E&T ) , administered 3-monthly for 2 years . Cyclical oral progestins were taken by those women with an intact uterus . Thirty-two women completed the study .  BMD ( DEXA ) of total body , lumbar vertebrae ( L1-L4 ) and hip area increased significantly in both treatment groups . BMD increased more rapidly in the testosterone treated group at all sites . A substantially greater increase in BMD occurred in the E&T group for total body ( P < 0.008 ) , vertebral L1-L4 ( P < 0.001 ) and trochanteric ( P < 0.005 ) measurements . All sexual parameters ( Sabbatsberg sexual self-rating scale ) improved significantly in both groups . Addition of testosterone result ed in a significantly greater improvement compared to E for sexual activity ( P < 0.03 ) , satisfaction ( P < 0.03 ) , pleasure ( P < 0.01 ) , orgasm ( P < 0.035 ) and relevancy ( P < 0.05 ) . Total cholesterol and LDL-cholesterol fell in both groups as did total body fat . Total body fat-free mass ( DEXA , anthropometry , impedance ) increased in the E&T group only . We concluded that in postmenopausal women , treatment with combined estradiol and testosterone implants was more effective in increasing bone mineral density in the hip and lumbar spine than estradiol implants alone . Significantly greater improvement in sexuality was observed with combined therapy , verifying the therapeutic value of testosterone implants for diminished libido in postmenopausal women . The favourable estrogenic effects on lipids were preserved in women treated with T , in association with beneficial changes in body composition CONTEXT Changes in and rogen levels across the adult female life span and the effects of natural menopause and oophorectomy have not been clearly established . OBJECTIVE The objective of this study was to document the effects of age on and rogen levels in healthy women and to explore the effects of natural and surgical menopause . DESIGN , SETTING , AND PARTICIPANTS A cross-sectional study was conducted of 1423 non-healthcare-seeking women , aged 18 - 75 yr , r and omly recruited from the community over 15 months . MAIN OUTCOME MEASURES Serum levels by age of total testosterone ( T ) , calculated free T , dehydroepi and rosterone sulfate , and and rostenedione in a reference group of women free of confounding factors . Women in the reference group had no usage of exogenous steroid therapy ; no history of tubal ligation , hysterectomy , or bilateral oophorectomy ; and no hyperprolactinemia or polycystic ovarian syndrome . The effects of natural and surgical menopause on sex steroid levels were also examined . RESULTS In the reference population ( n = 595 ) , total T , calculated free T , dehydroepi and rosterone sulfate , and and rostenedione declined steeply with age ( P < 0.001 ) , with the decline of each being greater in the earlier than the later decades . Examination of serum and rogen levels by year in women aged 45 - 54 yr showed no independent effect of menopausal status on and rogen levels . In women aged 55 yr or older , those who reported bilateral oophorectomy and were not on exogenous steroids had significantly lower total T and free T levels than women 55 yr or older in the reference group . CONCLUSIONS We report that serum and rogen levels decline steeply in the early reproductive years and do not vary because a consequence of natural menopause and that the postmenopausal ovary appears to be an ongoing site of testosterone production . These significant variations in and rogens with age must be taken into account when normal ranges are reported and in studies of the role of and rogens in women In a single-blind , placebo-controlled study , the effects of a 3-month oral administration of 160 mg/day testosterone undecanoate ( And riol ® ) on the quality of life of men with testosterone deficiency were evaluated . The subjects included ten men with primary hypogonadism and 29 with and ropause with sexual dysfunction as the most common problem . The changes in subjective symptoms were evaluated by the PNUH QoL scoring system and the St. Louis University Question naire for and rogen deficiency in aging males ( ADAM ) . Digital rectal examination ( DRE ) was performed and serum testosterone , prostate-specific antigen ( PSA ) and liver profile were monitored . Testosterone undecanoate treatment ( n = 33 ) significantly improved sexual dysfunction and symptom scores of metabolic , cardiopulmonary , musculo-skeletal and gastrointestinal functions compared to baseline and to placebo ( n = 6 ) . ADAM score also significantly improved after 3 months of treatment . Serum testosterone was significantly increased compared to pretreatment levels only in the testosterone undecanoate group . In the placebo group , no significant changes compared to baseline were found for testosterone levels and QoL question naires . No abnormal findings were detected on DRE or laboratory findings in either group . Adverse events , such as gastrointestinal problems and fatigue , were mild and self-limiting . It is concluded that and rogen supplement therapy with oral testosterone undecanoate ( And riol ) restores the quality of life through improvement of general body functions in men with testosterone deficiency OBJECTIVE To evaluate the effects of combination estrogen/ and rogen therapy on muscle mass , strength and endurance , serum hormone and lipid profiles , and quality of life measures in postmenopausal women . METHODS Prospect i ve , r and omized , placebo-controlled pilot study at a tertiary care medical center . Fifty postmenopausal women were r and omized to a 12-week course of ( 1 ) dehydroepi and rostenedione ( DHEA ) 50 mg daily , ( 2 ) conjugated equine estrogen ( CEE ) 0.625 mg daily , ( 3 ) DHEA 50 mg+CEE 0.625 mg daily , or ( 4 ) placebo . Main outcome measures of lower extremity muscle ( calf ) mass , functional muscle parameters , serum hormone and lipid levels , and quality of life ( QOL ) were obtained at baseline and after treatment . Statistical analysis compared percent change from baseline values and treatment differences among outcomes . RESULTS Significant increases in mean DHEA , DHEA sulfate ( DHEA-S ) , testosterone , and and rostenedione levels were noted with DHEA alone or combined DHEA/CEE treatments when compared with placebo . Compared with no hormone therapy , none of the supplemental hormone groups caused significant changes in muscle mass , muscle strength , muscle endurance , feelings of well-being , sleep , or sexual function . CONCLUSIONS And rogen replacement therapy , with DHEA , to menopausal women increases serum and rogen levels without any appreciable effect on muscle cross-sectional area , muscle strength , muscle function , or improvement in health-related QOL CONTEXT Available data concerning effects of testosterone on endometrium of postmenopausal women are seriously limited . OBJECTIVE Our aim was to compare the influence of treatment with testosterone and /or estrogen on endometrial proliferation in healthy postmenopausal women . DESIGN This was an open , r and omized clinical study with parallel comparison of the groups . SETTING The study was conducted at a women 's health clinical research unit and a research laboratory at a university hospital . PARTICIPANTS Sixty-three women who had experienced natural menopause participated in this study . INTERVENTIONS After r and om assignment , the participants were administered orally testosterone undecanoate ( 40 mg every second day ) , estradiol valerate ( 2 mg daily ) , or both for 3 months . MAIN OUTCOME MEASURES Endometrial thickness was measured , and endometrial proliferation evaluated on the basis of histopathology and expression of Ki-67 , a proliferation marker . RESULTS Endometrial thickness was significantly increased by treatment with estrogen alone or in combination with testosterone but was unaltered by testosterone alone . Among the women receiving estrogen alone , the proportion exhibiting histopathology indicative of proliferation increased significantly to 50 % ( P < 0.05 ) , there was a nonsignificant increase to 28 % with the combined treatment , whereas testosterone alone had no effect at all . Expression of Ki-67 was up-regulated significantly in both gl and s and stroma ( P < 0.05 , respectively ) in both estrogen treatment groups . However , the expression was significantly higher in stroma by estrogen treatment alone than after combined treatment ( P < 0.05 ) . CONCLUSIONS The short-term treatment with testosterone of postmenopausal women does not stimulate endometrial proliferation . In addition , testosterone appears to counteract endometrial proliferation induced by estrogen to a certain extent We conducted a double-blind , placebo-controlled study to determine the role of dietary supplementation on sexual function in women of differing menopausal status . One hundred eight ( 108 ) women , age 22–73 years , who reported a lack of sexual desire , enrolled as participants . Of these , 55 received ArginMax for women and 53 received placebo . ArginMax for women contains L-arginine , ginseng , ginkgo , damiana , multivitamins , and minerals . The 108 women , given definitions , self-reported as 59 premenopausal ( PRE ) ; 20 perimenopausal ( PERI ) , and 29 postmenopausal ( POST ) . After 4 weeks , PRE women on ArginMax primarily reported significant improvement in level of sexual desire ( 72 % ; p = 0.03 ) and satisfaction with overall sex life ( 68 % ; p = 0.007 ) , compared with placebo group , according to the Female Sexual Function Index ( FSFI ; Kaplan et al. , 1999 ) scales . Frequency of sexual desire ( 60 % ; p = 0.05 ) and frequency of intercourse ( 56 % p = 0.01 ) also increased among the PRE women . In contrast , among PERI women , primary improvements were reported for frequency of intercourse ( 86 % ; p = 0.002 ) , satisfaction with sexual relationship ( 79 % ; p = 0.03 ) , and vaginal dryness ( 64 % ; p = 0.03 ) compared with placebo group . POST women primarily showed an increased in level of sexual desire , with 51 % showing improvement , compared with only 8 % in the placebo group ( p = 0.008 ) . Nutritional intervention plays an important role in women 's sexual health , but issues and areas of greatest improvement differ among women of different menopausal states . The largest number of attribute improvements were seen in PRE and PERI women , although attribute types vary among these groups . Level of desire was shown to increase significantly in POST women . Since ArginMax for women has been shown to exhibit no estrogen activity , it may be desirable alternative to hormone therapy for sexual concerns Objective To study the effect on mammographic breast density of testosterone addition during combined estrogen/progestogen therapy in postmenopausal women . Methods A prospect i ve , r and omized , double-blind , placebo-controlled trial . A total of 99 women were given 2 mg 17β-estradiol and 1 mg norethisterone acetate in combination with either a testosterone patch ( 300 μg/24 h ) or a placebo patch . Mammographic breast density at baseline and after 6 months was assessed by visual classification scales and by digitized quantification . A st and ardized question naire was used to quantify subjective breast symptoms . Results Visual classifications showed an increase in mammographic density in 18–30 % of the women , with no significant differences between the treatment groups . The mean increase of the area of dense breast during treatment according to digitized assessment was 7.4 % in the placebo group and 5.4 % in the testosterone group . Breast symptoms showed a positive association with the increase in density ( rs = 0.34 ; p < 0.01 ) . Symptoms were most pronounced at 2 months of treatment . Density , both at baseline ( rs = −0.35 ; p < 0.01 ) and change during treatment ( rs = −0.28 ; p < 0.01 ) showed a negative association with free testosterone levels . Conclusion The addition of testosterone does not appear to influence mammographic breast density in women concurrently treated with a common oral estrogen/progestogen regimen for a period of 6 months The present study examined effects of testosterone on  hypoactive sexual desire in pre- and postmenopausal women ( treated ) compared with an age-matched reference group ( reference ) . Treated participants received 100 mg of testosterone cypionate in oil injected intramuscularly ( i.m . ) monthly for 3 months . We measured salivary testosterone and scores on the Sexual Desire Inventory pretreatment and posttreatment . Treated and reference participants ' baseline testosterone was equivalent , however , treated participants exhibited higher testosterone levels than did reference participants posttreatment . As expected , treated participants exhibited lower baseline sexual desire than did reference participants and showed a significant increase in sexual desire posttreatment . This research suggests that testosterone may effectively alleviate hypoactive sexual desire , even in women with normal testosterone levels Objective : Testosterone insufficiency has been associated with psychosexual problems , reduced psychological well-being , and negative metabolic consequences , whereas less is known about the effects on cognition . The aim of this study was to investigate the effect of adding testosterone to estrogen therapy on memory functions in oophorectomized women . Methods : In a r and omized , double-blind , placebo-controlled design , women with surgically induced menopause ( n = 50 ; mean [ SD ] age , 54.0 [ 2.9 ] y ) received estradiol valerate in combination with testosterone undecanoate or placebo . The women were assessed with a self-report question naire regarding memory and neuropsychological tests for verbal and spatial episodic memory and incidental learning at baseline , at the time of crossover , and after completion of treatment . Results : Testosterone undecanoate 40 mg added to estrogen therapy had a negative effect on immediate but not delayed verbal memory at 24 weeks . Subjective and objective memory showed some correspondence as the women in the estrogen + placebo treatment group rated decreased everyday memory problems at 24 weeks compared with baseline . This was not observed in the women in the estrogen + testosterone treatment . Verbal attention span deteriorated from baseline with estrogen + placebo treatment but not with the estrogen + testosterone treatment . However , there was no significant treatment effect between the two groups . Conclusions : Adding testosterone to estrogen treatment deteriorated immediate verbal memory compared with estrogen + placebo , while other memory functions were unaffected Aims /hypothesis Prospect i ve data directly investigating the role of endogenous sex hormones in diabetes risk have been scant , particularly in women . We aim ed to examine comprehensively plasma sex hormones in connection with risk of developing type 2 diabetes  in postmenopausal women . Methods We conducted a prospect i ve , nested case – control study of  plasma oestradiol , testosterone and dehydroepi and rosterone sulfate  and risk of type 2 diabetes in a cohort of women health professionals with a mean age of 60.3 and 12.2 years since menopause . Among women not using hormone therapy and free of baseline cardiovascular disease , cancer and diabetes , 359 incident cases of type 2 diabetes were matched with 359 controls during an average follow-up of 10 years . Results Oestradiol and testosterone were each strongly and positively associated with risk of type 2 diabetes . After adjustment for BMI , family history , lifestyle and reproductive variables , the multivariable relative risks ( 95 % CI ) comparing the highest vs lowest quintile were 12.6 ( 2.83–56.3 ) for total oestradiol ( p = 0.002 for trend ) , 13.1 ( 4.18–40.8 ) for free oestradiol ( p < 0.001 for trend ) , 4.15 ( 1.21–14.2 ) for total testosterone ( p = 0.019 for trend ) and 14.8 ( 4.44–49.2 ) for free testosterone ( p < 0.001 for trend ) . These associations remained robust after adjusting and accounting for other metabolic syndrome components and baseline HbA1c levels . Conclusions /interpretationIn postmenopausal women , higher plasma levels of oestradiol and testosterone were strongly and prospect ively related to increased risk of developing type 2 diabetes . These prospect i ve data indicate that endogenous levels of sex hormones may play important roles in the pathogenesis of type 2 diabetes . Clinical Trials.gov ID no. : NCT00000479 Objective : The extent to which aromatization of testosterone ( T ) to estradiol is required for the observed effects of testosterone therapy on sexual function and well-being are not known . Therefore , the authors investigated the effects of aromatase enzyme inhibition on sexual function , well-being , and mood in estrogen- and T-replete postmenopausal women in a double-blind , r and omized , placebo-controlled study . Design : Postmenopausal women using transdermal estrogen therapy for at least 8 weeks and reporting low sexual satisfaction ( score < 42 for the Sabbatsberg Sexual Self-rating Scale [ SSS ] ) with a total T value of less than 1.2 nmol/L were treated with 400 μL of a 0.5 % T gel ( total dose 2 mg ) and were r and omly assigned to receive treatment with either 2.5 mg/day of letrozole or an identical placebo tablet . Women were assessed at baseline ( week −2 ) and at 0 , 4 , 8 , and 16 weeks . Sexual function was assessed with the SSS , well-being was assessed with the Psychological General Well-being Index , and mood was assessed with the Beck Depression Inventory at 0 and 16 weeks . Eighty-one women were screened , 76 were r and omly assigned to a treatment group , and 30 in each group completed the study . Because this was a mechanistic study , only the 60 women who completed the study per protocol were included in the final analysis . Results : Total T and calculated free T increased from baseline in both groups , with no difference between groups . At 16 weeks , estradiol , sex hormone-binding globulin , fasting lipids , lipoprotein(a ) , and C-reactive protein did not differ from baseline or between groups . Significant increases in total Sabbatsberg Sexual Self-rating Scale scores , total Psychological General Well-being Index scores , and a reduction in Beck Depression Inventory scores from baseline to 16 weeks was seen for both treatment groups , with no effect of treatment allocation . No adverse treatment effects were reported . Conclusions : Increases in total and free T in the physiologic range in postmenopausal women were associated with improved sexual satisfaction , well-being , and mood . In this study , aromatase inhibition did not influence any of these outcomes . Short-term transdermal T therapy did not modify fasting lipids , lipoprotein(a ) , or C-reactive protein OBJECTIVES And rogen deficiency has been associated with the development of systemic lupus erythematosus ( SLE ) . The aim of this study was to test the efficacy of testosterone patches vs placebo in female SLE patients with baseline mild-to-moderate disease activity in a r and omized , double-blind , single-centre placebo-controlled trial . METHODS Patients received testosterone ( 150 microg ) or placebo transdermal patches for 12 weeks . Patients were assessed at 4-weekly intervals for disease activity using the Safety of Oestrogens in Lupus Erythematosus National Assessment -SLE Disease Activity Index ( SELENA-SLEDAI ) , Systemic Lupus Activity Measure-Revised ( SLAM-R ) and The British Isles Lupus Assessment Group ( BILAG ) indices , physician global assessment ( PGA ) , quality of life using the SF-36 survey and sexual functioning using the Derogatis score . Data were analysed using two sample t-tests to compare the mean difference from baseline to week 12 in the testosterone patch and placebo groups . RESULTS Thirty-four patients were recruited in to each group . There was no significant baseline difference between the groups in age , race or marital status . There was no significant difference between treatment groups in the mean change in SELENA-SLEDAI ( 0.547 + /- 3.72 , P > 0.60 ) , nor in PGA or BILAG system scores . The mean change in SLAM-R score was statistically different ( 2.06 , S.D. 3.3 , P = 0.01 ) but was not considered clinical ly meaningful . Health transition also showed a small change ( P < 0.03 ) . There was no significant difference in the Derogatis scores or toxicity . CONCLUSIONS Testosterone patches were safe but did not significantly affect disease activity , quality of life or sexual functioning . Increased use of steroids in the placebo group may have confounded the study results Objective To assess the effect of  combined hormone replacement therapy ( HRT )  on health related quality of life . Design R and omised placebo controlled double blind trial . Setting General practice s in United Kingdom ( 384 ) , Australia ( 94 ) , and New Zeal and ( 24 ) . Participants Postmenopausal women aged 50 - 69 at r and omisation ; 3721 women with a uterus were r and omised to combined oestrogen and progestogen  ( n=1862 ) or placebo  ( n=1859 ) . Data on health related quality of life at one year were available from 1043 and 1087 women , respectively . Interventions Conjugated equine oestrogen 0.625 mg plus medroxyprogesterone acetate 2.5/5.0 mg or matched placebo orally daily for one year . Main outcome measures Health related quality of life and psychological wellbeing as measured by the women ’s health question naire . Changes in emotional and physical menopausal symptoms as measured by a symptoms question naire and depression by the Centre for Epidemiological Studies depression scale ( CES-D ) . Overall health related quality of life and overall quality of life as measured by the European quality of life instrument ( EuroQol ) and visual analogue scale , respectively . Results After one year small but significant improvements were observed in three of nine components of the women ’s health question naire for those taking combined HRT compared with those taking placebo :  vasomotor symptoms ( P<0.001 ) , sexual functioning ( P<0.001 ) , and sleep problems ( P<0.001 ) . Significantly fewer women in the combined HRT group reported hot flushes ( P<0.001 ) , night sweats ( P<0.001 ) , aching joints and muscles ( P=0.001 ) , insomnia ( P<0.001 ) , and vaginal dryness ( P<0.001 ) than in the placebo group , but greater proportions reported breast tenderness ( P<0.001 ) or vaginal discharge ( P<0.001 ) . Hot flushes were experienced in the combined HRT and placebo groups by 30 % and 29 % at trial entry and 9 % and 25 % at one year , respectively . No significant differences in other menopausal symptoms , depression , or overall quality of life were observed at one year . Conclusions Combined HRT started many years after the menopause can improve health related quality of life . Trial registration IS RCT N 63718836 Most studies of sex hormones and insulin resistance ( IR ) have focused on and rogens ; few have examined the association of endogenous estrogens and IR . We determined the cross-sectional association of endogenous levels of total and bioavailable testosterone and estradiol and SHBG with IR among 845 healthy , postmenopausal women aged 45 - 65 yr . Women were within 10 yr of menopause and not using hormone replacement therapy .  Total adiposity was estimated by body mass index , visceral adiposity by waist to hip ratio ( WHR ) , and IR by the homeostasis model assessment . We defined homeostasis model assessment -IR as the highest quartile ( cutpoint , 2.1 ) of the distribution in this cohort . In logistic regression analyses , the odds for IR were significant and increased in a dose-response fashion across each quartile of total estradiol , bioavailable estradiol , and bioavailable testosterone ( all P < 0.001 for linear trend ) . These associations remained significant after adjusting for WHR ; adjusted odds ratios were 4.0 , 6.1 , and 2.7 for total estradiol , bioavailable estradiol , and bioavailable testosterone , respectively , comparing the highest to the lowest quartile ( all P < 0.001 ) . Adjusting for body mass index and WHR together eliminated the linear association of IR with total estradiol and bioavailable testosterone , but the association with bioavailable estradiol remained ( adjusted odds ratio , 2.7 ; P < 0.001 , comparing the highest to the lowest quartile ) . IR was not associated with total testosterone before or after adjusting for adiposity . Lower SHBG levels were associated with higher odds of IR , independent of adiposity . These results suggest that estrogen may be equally or more important than testosterone in the pathway to IR in healthy , young postmenopausal women , with differences not entirely explained by body size INTRODUCTION A significant number of postmenopausal women suffer from distressing problems because of urogenital atrophy secondary to the decline in circulating estrogen levels . Treatment with topical hormones may provide relief in such women when used judiciously . AIM To study the effects of local estrogen with or without local testosterone on urogenital and sexual health in postmenopausal women . METHODS Seventy-five postmenopausal women symptomatic for urogenital atrophy and sexual dysfunction were r and omly divided into two study groups and one control group . The women in study group 1 received local estrogen cream ; study group 2 received local estrogen and testosterone cream ; the control group received nonhormonal lubricant KY gel for 12 weeks . The urogenital and sexuality score , along with the vaginal health index and the vaginal maturation index ( VMI ) , was calculated at the beginning of therapy and 12 weeks later . MAIN OUTCOME MEASURES Changes in the urogenital and sexuality score along with vaginal health index and VMI . RESULTS After 12 weeks of therapy , there was a significant improvement in all the four study parameters , which correlated well with the improvement in symptoms of urogenital atrophy and sexual dysfunction in both the study groups as compared with the control group . Improvement in sexuality score was greatest with combined estrogen- and rogen therapy . There were no adverse effects and the therapies were well accepted without any compliance issue . CONCLUSION Local estrogen either alone or with and rogen is highly effective in relieving symptoms of urogenital atrophy and in improving sexual function in symptomatic postmenopausal women Objective This study aims to determine the dose-dependent effects of testosterone on sexual function , body composition , muscle performance , and physical function in hysterectomized women with or without oophorectomy . Methods Seventy-one postmenopausal women who previously underwent hysterectomy with or without oophorectomy and had total testosterone levels less than 31 ng/dL or free testosterone levels less than 3.5 pg/mL received a st and ardized transdermal estradiol regimen during the 12-week run-in period and were r and omized to receive weekly intramuscular injections of placebo or 3 , 6.25 , 12.5 , or 25 mg of testosterone enanthate for 24 weeks .  Total and free testosterone levels were measured by liquid chromatography – t and em mass spectrometry and equilibrium dialysis , respectively . The primary outcome was change in sexual function measured by the Brief Index of Sexual Functioning for Women . Secondary outcomes included changes in sexual activity , sexual distress , Derogatis Interview for Sexual Functioning , lean body mass , fat mass , muscle strength and power , and physical function .  Results Seventy-one women were r and omized ; five groups were similar at baseline . Sixty-two women with analyzable data for the primary outcome were included in the final analysis . The mean on-treatment total testosterone concentrations were 19 , 78 , 102 , 128 , and 210 ng/dL in the placebo , 3-mg , 6.25-mg , 12.5-mg , and 25-mg groups , respectively . Changes in composite Brief Index of Sexual Functioning for Women scores , thoughts/desire , arousal , frequency of sexual activity , lean body mass , chest-press power , and loaded stair-climb power were significantly related to increases in free testosterone concentrations ; compared with placebo , changes were significantly greater in women assigned to the 25-mg group , but not in women in the lower-dose groups . Sexual activity increased by 2.7 encounters per week in the 25-mg group . The frequency of and rogenic adverse events was low . Conclusions Testosterone administration in hysterectomized women with or without oophorectomy for 24 weeks was associated with dose and concentration-dependent gains in several domains of sexual function , lean body mass , chest-press power , and loaded stair-climb power . Long-term trials are needed to weigh improvements in these outcomes against potential long-term adverse effects We previously reported that a high soya diet improved memory and frontal lobe function in young volunteers , and since soya isoflavones are agonists at oestrogen receptors , they may improve these functions in postmenopausal women . Thirty-three postmenopausal women ( 50 - 65 years ) not receiving conventional hormone replacement therapy ( HRT ) were r and omly allocated in a double-blind parallel study to receive a soya supplement ( 60 mg total isoflavone equivalents/day ) or placebo for 12 weeks . They received a battery of cognitive tests and completed analogue rating scales of mood and sleepiness , and a menopausal symptoms question naire before the start of treatment and then after 12 weeks of treatment . Those receiving the isoflavone supplement showed significantly greater improvements in recall of pictures and in a sustained attention task . The groups did not differ in their ability to learn rules , but the isoflavone supplement group showed significantly greater improvements in learning rule reversals . They also showed significantly greater improvement in a planning task . There was no effect of treatment on menopausal symptoms , self-ratings of mood , bodily symptoms or sleepiness . Thus , significant cognitive improvements in postmenopausal women can be gained from 12 weeks of consumption of a supplement containing soya isoflavones that are independent of any changes in menopausal symptoms , mood or sleepiness OBJECTIVES To eluci date if percutanous treatment with 10 mg testosterone per day could enhance sexuality and psychological well-being in postmenopausal women presenting problems with low libido . Secondary to study the influence on blood lipids , hemoglobin and erythropoietin levels . METHODS Fifty-three postmenopausal women participated . As a complement to their already on-going HRT , 10 mg of a testosterone gel ( Testogel , Besins-Iscovesco ) or placebo was administered . Treatment continued for three plus three months in a double blind , r and omized , crossover design . RESULTS The scores concerning " frequency of sexual activity , orgasm and intercourse " , " sexual arousal , fantasies and enjoyment " , " satisfaction with orgasms " , and " interest in sex " were all significally improved for testosterone addition as compared to placebo both before and after crossover . Testosterone levels increased more than 10-fold during treatment while DHT-levels were more than doubled . Estrogen levels were not affected during the addition of testosterone . Liver enzymes , total cholesterol , triglycerides , HDL and LDL revealed no significant differences between any of the periods or groups . Endometrial thickness did not change significantly during treatment . Hemoglobin and erythropoietin remained unchanged . No significant differences in the number of experienced side effects were found . CONCLUSION Testosterone gel of 10 mg had positive effects on several aspects of sexual life such as frequency of sexual activity , orgasm , arousal , fantasies and sexual interest in postmenopausal women on HRT . Several psychological variables were positively influenced . The given dose result ed in too high serum levels . Even if no negative effects were observed , monitoring of serum levels and a decreased dose should be considered in future studies Sexual dysfunction is present the most important problem among menopausal women and thus counseling may have a major role for improving menopausal sexual state in this population . We aim ed to assess effects of counseling on sexual function of menopause women and their spouses . An interventional trial study was performed on 120 consecutive Iranian couples ( menopause women and their spouses ) who were resident in Hamadan , Iran in 2015 . The subjects were r and omly assigned to  receive counseling service ( n = 60 ) or did not receive this service ( n = 60 ) . Couples were asked to complete a st and ardized vali date d question naire assessing sexual function and behaviors . The frequency of sexual intercourse was considerably increased following first and second counseling sessions compared with the time before counseling in former group , while sexually state was remained unchanged in those who not received these counseling . Furthermore , dyspareunia in interventional women with counseling was significantly reduced after the first and second counseling , whereas this complaint was not significantly removed in the control group within the study period . Also , unsuccessful intercourse was significantly decreased in men who received counseling sessions , while this parameter was remained unchanged in other men . In addition , talking with the partner about sexually and Satisfaction degree of wife ’s love was significantly improved in both men and women in interventional groups compared with the control groups . Active and structured counseling effectively improve sexual functions and behaviors in menopausal women and their spouses The effect of estrogen and /or and rogen replacement therapy on several aspects of cognitive functioning in surgically menopausal women was tested in a prospect i ve , crossover design . Women who received either a combined estrogen- and rogen preparation , estrogen alone , or and rogen alone had scores on two tests of short-term memory , a test of long-term memory and a test of logical reasoning that were not different during the postoperative treatment phase compared to their preoperative performance . However , oophorectomized women who received placebo had lower scores on all four measures of cognitive functioning postoperatively , coincident with their significantly lower concentrations of plasma estradiol and testosterone .  Patients who had a hysterectomy but whose ovaries were retained showed stability both in cognitive performance and in circulating sex steroid concentrations . These findings suggest that the drastic change in endocrine milieu following surgical menopause may have a direct , albeit modest , effect on aspects of cognitive functioning . Possible mechanisms of action of the sex hormones on cognitive functioning in women are discussed Percutaneous estradiol ( E2 ) implants effectively preserve bone density in postmenopausal women . However , these implants are often given with testosterone , which may itself have an anabolic effect on bone . To determine whether testosterone confers any additional bone-sparing effect , we studied 50 postmenopausal women r and omly allocated to receive E2  ( 75 mg ) alone or with testosterone ( 100 mg ) every 6 months for 1 year . Women with an intact uterus received cyclic norethindrone ( 5 mg ) for 10 days of each calendar month . Twenty-five untreated women were recruited to act as a reference group . Bone density was measured at the lumbar spine and proximal femur by dual x-ray densitometry . By 1 year , bone density at the lumbar spine had fallen by 1.8 % in the reference group . In the women treated with E2 alone , it increased significantly by 7.8 % ( P < .0001 ) and in those receiving E2 with testosterone , it increased by 6.3 % ( P < .0001 ) . At the femoral neck , bone density decreased by 3 % in the controls and increased by approximately 4 % in both treated groups ( P < .0001 ) . The increase in bone density at these sites was unrelated to the woman 's chronological age , menopausal age , or initial bone density . However , it correlated significantly with the serum E2 levels attained after 1 year of therapy . In no treated patients did bone density decrease significantly . These data show that testosterone confers no additional bone-sparing effect in postmenopausal women Objective This study aim ed to explore the effects of continuous-combined estradiol 1 mg/drospirenone 2 mg ( E2D ) on cognitive performance in healthy , recently postmenopausal women . Methods A 6-month r and omized , double-blind , placebo-controlled study was carried out in a university research center . Participants were 23 healthy postmenopausal women aged 49 to 55 years . Cognitive performance was assessed with a computerized cognitive battery administered to all participants on 0 , 12 , and 26 weeks . Functional magnetic resonance imaging was performed on 13 participants before and after treatment using tasks of verbal fluency and mental rotation . Results E2D was not associated with an overall effect on cognitive performance . Functional magnetic resonance imaging results showed no difference between the groups for verbal fluency or mental rotation task performance at baseline . The mental rotation task was associated with increased blood oxygen level – dependent signalling in the placebo group in both occipital lobes and in the left superior parietal lobe after 26 weeks ( P < 0.05 ) , with no changes over time seen in the treatment group . The total menopausal symptom and sexual function domain scores improved after treatment in women r and omized to E2D compared with the placebo group ( both P < 0.05 ) . Similarly , systolic blood pressure , weight , and body mass index were significantly lower in women r and omized to E2D at 26 weeks ( P < 0.05 ) . Conclusions E2D has no detrimental effect on cognitive performance in early postmenopausal women . E2D significantly improves menopausal symptoms , sexual function , systolic blood pressure , and weight
Some studies suggest that testosterone therapy has additional effects , which include increased bone mineral density and decreased serum high-density lipoprotein ( HDL ) cholesterol .
The clinical sequelae of oestrogen deficiency during menopause are undoubted .
However , the pathophysiological role of testosterone during the menopause is less clear .
Several r and omized , placebo-controlled clinical trials suggest that testosterone therapy improves sexual function in postmenopausal women .