Androgens are hormones that are important to the integrity of skin, muscle, and bone in both males and females, and have an important role in maintaining libido. Declines in serum testosterone are associated with hysterectomy, menopause, and age-related gender-independent decreases in DHEA and DHEA-sulfate.
DHEA (dehydroepiandrosterone) is an androgen precursor from which the body can derive testosterone. After menopause, a woman’s ovaries continue to produce androgens; however, the majority of the androgens produced in the female body, even before menopause, come from peripheral conversion of DHEA. As the body ages, production of DHEA declines so that by the time a woman goes through menopause, the production of DHEA is often inadequate. Additionally, estrogen replacement therapy (ERT) may cause relative ovarian and adrenal androgen deficiency, creating a rationale for concurrent physiologic androgen replacement. Recently, attention has turned to the addition of the androgens to a woman’s BHRT regimen in order to alleviate recalcitrant menopausal symptoms and further protect against osteoporosis, loss of immune function, obesity, and diabetes.
Androgens, such as testosterone and DHEA:
- enhance libido.
- enhance bone building (increase calcium retention).
- provide cardiovascular protection (lower cholesterol).
- improve energy level and mental alertness.
Proper selection of specific hormones, doses, and routes of administration can provide significant clinical advantages. Non-oral (transdermal) estrogens do not undergo first pass hepatic metabolism, have minimal effects on clotting factors, and are associated with potential advantages on the cardiovascular system and blood pressure control. In particular, the risk of developing deep vein thrombosis or pulmonary thromboembolism (blood clots) is negligible with transdermal administration when compared to oral estrogens. In addition, evidence shows that bio-identical progesterone has a favorable action on the blood vessels and on the brain, while this might not be true for some synthetic progestins. Recent trials indicate that the us of bio-identical progesterone with estrogens confers less or even no risk of breast cancer as opposed to the use of synthetic progestins. In conclusion, the choice of the transdermal route of administration of estrogens and the use of bio-identical progesterone might offer significant benefits and added safety.