Leão Lenora M Camarate S M, Duarte Mônica Peres C, Silva Dalva Margareth B, Bahia Paulo Roberto V, Coeli Cláudia Medina, de Farias Maria Lucia Fleiuss
Service of Endocrinology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil.
Eur J Endocrinol. 2006 Jan;154(1):131-9. doi: 10.1530/eje.1.02065.
There has been a growing interest in treating postmenopausal women with androgens. However, hyperandrogenemia in females has been associated with increased risk of cardiovascular disease.
We aimed to assess the effects of androgen replacement on cardiovascular risk factors.
Thirty-seven postmenopausal women aged 42-62 years that had undergone hysterectomy were prospectively enrolled in a double-blind protocol to receive, for 12 months, percutaneous estradiol (E2) (1 mg/day) combined with either methyltestosterone (MT) (1.25 mg/day) or placebo.
Along with treatment, we evaluated serum E2, testosterone, sex hormone-binding globulin (SHBG), free androgen index, lipids, fibrinogen, and C-reactive protein; glucose tolerance; insulin resistance; blood pressure; body-mass index; and visceral and subcutaneous abdominal fat mass as assessed by computed tomography.
A significant reduction in SHBG (P < 0.001) and increase in free testosterone index (P < 0.05; Repeated measures analysis of variance) were seen in the MT group. Total cholesterol, triglycerides, fibrinogen, and systolic and diastolic blood pressure were significantly lowered to a similar extent by both regimens, but high-density lipoprotein cholesterol decreased only in the androgen group. MT-treated women showed a modest rise in body weight and gained visceral fat mass relative to the other group (P < 0.05), but there were no significant detrimental effects on fasting insulin levels and insulin resistance.
This study suggests that the combination of low-dose oral MT and percutaneous E2, for 1 year, does not result in expressive increase of cardiovascular risk factors. This regimen can be recommended for symptomatic postmenopausal women, although it seems prudent to perform baseline and follow-up lipid profile and assessment of body composition, especially in those at high risk of cardiovascular disease.
使用雄激素治疗绝经后女性的兴趣日益浓厚。然而，女性高雄激素血症与心血管疾病风险增加有关。
我们旨在评估雄激素替代对心血管危险因素的影响。
37名年龄在42 - 62岁且已接受子宫切除术的绝经后女性被前瞻性纳入一项双盲方案，接受为期12个月的经皮雌二醇（E2）（1毫克/天）联合甲基睾酮（MT）（1.25毫克/天）或安慰剂治疗。
在治疗过程中，我们评估了血清E2、睾酮、性激素结合球蛋白（SHBG）、游离雄激素指数、血脂、纤维蛋白原和C反应蛋白；葡萄糖耐量；胰岛素抵抗；血压；体重指数；以及通过计算机断层扫描评估的内脏和皮下腹部脂肪量。
MT组SHBG显著降低（P < 0.001），游离睾酮指数升高（P < 0.05；重复测量方差分析）。两种治疗方案均使总胆固醇、甘油三酯、纤维蛋白原以及收缩压和舒张压显著降低至相似程度，但高密度脂蛋白胆固醇仅在雄激素组中降低。与另一组相比，接受MT治疗的女性体重略有增加，内脏脂肪量增加（P < 0.05），但对空腹胰岛素水平和胰岛素抵抗无显著不利影响。
本研究表明，低剂量口服MT与经皮E2联合使用1年不会导致心血管危险因素显著增加。对于有症状的绝经后女性，可推荐此治疗方案，尽管对心血管疾病高危人群进行基线和随访血脂谱以及身体成分评估似乎更为谨慎。
