Clinical review: The benefits and harms of systemic testosterone therapy in
postmenopausal women with normal adrenal function: a systematic review and
meta-analysis.
Author(s): Elraiyah T(1), Sonbol MB, Wang Z, Khairalseed T, Asi N, Undavalli C, Nabhan M,
Firwana B, Altayar O, Prokop L, Montori VM, Murad MH.
Affiliation(s): Author information:
(1)Knowledge and Evaluation Research Unit (T.E., M.B.S., Z.W., T.K., N.A., C.U.,
M.N., B.F., O.A., V.M.M., M.H.M.), and Center for the Science of Healthcare
Delivery (T.E., Z.W., N.A., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905;
Internal Medicine Department (M.B.S.), Georgia Regents University, Augusta,
Georgia 30901; and Mayo Clinic Libraries (L.P.), Division of Endocrinology,
Diabetes, Metabolism and Nutrition (V.M.M.), and Division of Preventive,
Occupational, and Aerospace Medicine (M.H.M.), Mayo Clinic, Rochester, Minnesota
55905.
Publication date & source: 2014, J Clin Endocrinol Metab. , 99(10):3543-50
CONTEXT: The use of T has been suggested to improve women's health during the
postmenopausal period.
OBJECTIVE: We conducted a systematic review and meta-analysis of randomized
trials to summarize the best available evidence regarding the benefits and harms
of systemic T in postmenopausal women with normal adrenal function.
METHODS: A comprehensive search of MEDLINE, EMBASE, PsycInfo, Cochrane Central
Register of Controlled Trials, Cochrane Database of Systematic Reviews, EBSCO
CINAHL, and Scopus was conducted through January 2014. We conducted study
selection, data extraction, and appraisal in duplicate. Random-effects
meta-analysis was used to pool results.
RESULTS: We identified 35 randomized trials (n = 5053) at a moderate risk of
bias. T use was associated with statistically significant improvement in various
domains of sexual function and personal distress in postmenopausal women,
although the majority of the trials did not have specific or contemporary
diagnostic criteria for androgen deficiency in women. T use was also associated
with a reduction in total cholesterol, triglyceride, and high-density lipoprotein
and an increase in low-density lipoprotein and in the incidence of acne and
hirsutism. No significant effect was noted on anthropometric measures and bone
density. Long-term safety data were sparse, and the quality of such evidence was
low.
CONCLUSION: Despite the improvement in sexual function associated with T use in
postmenopausal women, long-term safety data are lacking.
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