Sarrel P, Dobay B, Wiita B
Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut 06250, USA.
J Reprod Med. 1998 Oct;43(10):847-56.
To investigate the efficacy of esterified estrogens alone and combined with oral androgen on sexual function and menopausal symptoms in postmenopausal women.
Twenty postmenopausal women dissatisfied with their estrogen or estrogen-progestin therapy volunteered to enter a double-blind, randomized trial in which they received either oral esterified estrogens or esterified estrogens + androgen for eight weeks after a single-blind, placebo, lead-in period. Sexual function was assessed with a questionnaire used in the Yale midlife survey, and plasma levels of estradiol, estrone, sex hormone binding globulin (SHBG) and beta-endorphin were measured at two- to four-week intervals.
Estrogen-androgen therapy significantly improved sexual sensation and desire after four and eight weeks of double-blind treatment in comparison to previous estrogen therapy and postplacebo baseline assessments. Plasma levels of estradiol and estrone increased significantly in all patients as compared to the postplacebo baseline and decreased in comparison to circulating estrogen concentrations on previous therapy. Relative proportions of free and bound steroid hormone exhibited contrasting shifts during estrogen and estrogen-androgen therapy. SHBG increased in the estrogen group and decreased in the estrogen-androgen group, leading to lower amounts of free androgens during estrogen therapy and increased free androgen levels during estrogen-androgen therapy. Since proportions of free (bioavailable) ovarian steroids would correlate inversely with plasma protein binding capacity, the beneficial effects of oral estrogen-androgen therapy on sexual sensation and desire may be due either to the administered androgen or to the increased availability of endogenous and exogenous androgens, particularly in the central nervous system.
Sexual desire, satisfaction and frequency in postmenopausal women taking hormonal therapy were improved significantly by combined estrogen-androgen therapy but not by estrogen or estrogen-progestin therapy. Sexual function improved with estrogen-androgen therapy even though circulating estrogen levels were lower than those measured during previous estrogen therapy. This leads to the conclusion that androgens play a pivotal role in sexual function but that estrogens are not a significant factor determining levels of sexual drive and enjoyment.
探讨单独使用酯化雌激素以及联合口服雄激素对绝经后女性性功能和绝经症状的疗效。
20名对雌激素或雌激素 - 孕激素治疗不满意的绝经后女性自愿参加一项双盲、随机试验。在单盲、安慰剂导入期后，她们接受口服酯化雌激素或酯化雌激素 + 雄激素治疗，为期8周。使用耶鲁中年调查中使用的问卷评估性功能，并每隔2至4周测量雌二醇、雌酮、性激素结合球蛋白（SHBG）和β - 内啡肽的血浆水平。
与先前的雌激素治疗和安慰剂后基线评估相比，双盲治疗4周和8周后，雌激素 - 雄激素治疗显著改善了性感觉和性欲。与安慰剂后基线相比，所有患者的血浆雌二醇和雌酮水平显著升高，与先前治疗时的循环雌激素浓度相比则降低。在雌激素和雌激素 - 雄激素治疗期间，游离和结合类固醇激素的相对比例呈现相反的变化。雌激素组中SHBG升高，雌激素 - 雄激素组中SHBG降低，导致雌激素治疗期间游离雄激素量减少，而雌激素 - 雄激素治疗期间游离雄激素水平升高。由于游离（生物可利用）卵巢类固醇的比例与血浆蛋白结合能力呈负相关，口服雌激素 - 雄激素治疗对性感觉和性欲的有益作用可能归因于所给予的雄激素，或者是内源性和外源性雄激素可用性的增加，特别是在中枢神经系统中。
联合雌激素 - 雄激素治疗可显著改善接受激素治疗的绝经后女性的性欲、满意度和频率，而雌激素或雌激素 - 孕激素治疗则不能。尽管循环雌激素水平低于先前雌激素治疗期间测得的水平，但雌激素 - 雄激素治疗仍改善了性功能。由此得出结论，雄激素在性功能中起关键作用，而雌激素不是决定性欲和性快感水平的重要因素。
