Abstract
There is increasing interest in the use of menopausal androgen replacement therapy
(MART) in symptomatic women undergoing natural or surgical menopause. However, the
efficacy of MART in alleviating these symptoms compared to traditional estrogen/progestin
hormone replacement therapy remains a subject of debate. Accordingly, attention must
be focused on the side-effects of the various MART preparations. The dose, alkylation,
and route of administration of these compounds influences the development of side
effects. While all androgens are potential virilizing agents, alkylated compounds
have an additional risk of inducing severe hepatic consequences, regardless of their
route of administration. Fortunately, the lower doses administered to women compared
to men has not resulted in significant hepatic events. Generation of an adverse lipoprotein
profile is possible but is not addressed in this article. Thus, virilizing and cutaneous
side effects remain the primary concern. While some observational studies indicate
acne and/or hirsutism are evident in up to 38% and 36% of oral methyltestosterone-treated
patients, respectively, other studies performed in a prospective fashion suggest a
much lower incidence of approximately 5%. Other reported virilizing effects include
deepening of the voice and clitoromegaly. Additional concerns are related to risks
of developing endometrial hyperplasia when MART is used in conjunction with estrogens.
Fortunately, concomitant progestin administration is protective. Finally, there is
a theoretical concern that MART may increase the risk of developing breast cancer
but this has not been demonstrated in clinical practice. Overall, the safety profile
of MART appears to be acceptable when dosing avoids supraphysiologic testosterone
levels.
Keywords:
Androgens - menopause - hormone replacement therapy - methyltestosterone - acne -
hirsutism - ERT
