Risks of menopausal androgen supplementation

There is increasing interest in the use of menopausal androgen replacement therapy (MART) in symptomatic women undergoing natural or surgical menopaus e. However, the efficacy of MART in alleviating these symptoms compared to traditional estrogen/progestin hormone replacement therapy remains a subjec t of debate. Accordingly, attention must be focused on the side-effects of the various MART preparations. The dose, alkylation, and route of administr ation 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 thei r route of administration. Fortunately, the lower doses administered to wom en compared to men has not resulted in significant hepatic events. Generati on of an adverse lipoprotein profile is possible but is not addressed in th is article. Thus, virilizing and cutaneous side effects remain the primary concern. While some observational studies indicate acne and/or hirsutism ar e evident in tip 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 administrat ion is protective. Finally, there is a theoretical concern that MART may in crease the risk of developing breast cancer but this has not been demonstra ted in clinical practice. Overall, the safety profile of MART appears to be acceptable when dosing avoids supraphysiologic testosterone levels.