Androgens in Health and Disease.pdf - E Library

276 Bancroft
either E and T or placebo implants. Results showed significant symptom improvement
across the board for the first 4 mo after active implant, but with some return of symptoms
in the fifth and sixth months. There was no significant improvement in any symptom on
the placebo implant, at any stage of the 6 mo. These results demonstrate the value of this
combined regime, but do not evaluate the specific role of testosterone. The authors
conclude that return of symptoms in the last 2 mo when E 2 and T levels were still within
the normal range indicates that changing levels of E 2 and T are more important than
absolute levels. Burger et al. (105) reported on 17 women, 11 of whom had undergone
surgical menopause. They were selected because they complained of persistent symptoms,
particularly loss of libido, in spite of treatment with Premarin 1.25 mg daily or
Progynova 4 mg daily. They were given combined implants of E and T and assessed over
6 mo. Tiredness, lack of concentration and all measures of sexuality improved over the
first 3 mo but relapsed over the last 3 mo. Once again, return of symptoms occurred in
the presence of normal premenopausal levels of E 2 and T.
In the most sophisticated study in this field, Sherwin et al. (106) investigated women
undergoing hysterectomy and bilateral oophorectomy. A 1-mo baseline assessment
preceded the surgery. Postoperatively, women were assigned randomly to one of four
treatment groups: estrogen only (E), testosterone only (T), estrogen plus testosterone
(E+T), or placebo. These were given in monthly injections for 3 mo. All subjects then
received 1 mo of placebo, following which they were crossed over to one of the other
three treatment groups. A fifth group of younger women who had undergone hysterectomy
only was assessed in the same way as a control for the effects of surgery. The E+T
and T only conditions showed significantly higher levels of sexual interest, fantasy, and
arousal than either the E only or placebo conditions. They did not differ in measures of
sexual activity with partner or orgasm. Apart from its design, this study is also noteworthy
because it focused on the immediate postoperative period in women who were not
reporting significant sexual or mood problems preoperatively. In a separate article (107),
the effects on mood were reported, showing that mood was significantly better with all
three hormone regimes compared with placebo. The T-only group also had significantly
higher hostility scores than the other three groups. In a third article (108), it was reported
that energy level, well-being, and appetite were significantly higher in the two groups
receiving T than in the E-only or placebo groups.
Sherwin and Gelfand (109) went on to study three groups of women, all of whom had
been oophorectomized. One group had been established on a previous E+T regime; one
group received monthly injections of E alone, and the third group had received no
treatment (NT). Striking increases in sexual desire, fantasies, and arousal occurred in
the E+T group 1 wk after the injection but by the second week, these variables were
declining. By the fourth week, there were no differences between the E+T group and
either the E or NT groups. In a separate article, Sherwin (110) reported on the mood
changes in this study. The E+T group showed significantly less negative mood, in terms
of anxiety, depression, hostility, tiredness, and clear headedness, than the NT group.
The E+T group was also less anxious, depressed, and tired than the E group on d 8
postinjection (when improvement in the sexual variables was around maximal), “coincident
with their higher levels of circulating T at that time.” However, because mood
correlated with E 2 levels and these levels remained within the physiological range and
because T levels remained supraphysiological throughout, Sherwin concluded that the
mood effects were the result of the E and not the T. It is not clear why E was clearly