Cardiovascular and sexual health effects of postmenopausal testosterone therapy

Abstract

Introduction:

Testosterone is frequently used as part of postmenopausal hormone therapy (HT) but few preparations have been approved for use in women. The effects of androgens on the female cardiovascular (CV) system remain poorly understood and concerns exist over the long-term CV safety of testosterone therapy. This study aimed to investigate the CV effects of the transdermal testosterone patch (TTP) in postmenopausal women, on concomitant HT, using surrogate markers for CV disease.

Methods:

This open label pilot study investigated the effects of 12 weeks TTP on arterial stiffness and endothelial function in 21 postmenopausal women. Primary outcome measures were augmentation index (AIx), assessed by pulse wave analysis (PWA), reactive hyperaemic index (RHI) using peripheral arterial tonometry (PAT) and insulin resistance using the homeostasis model (HOMA-IR). Libido (brief profile of female sexual function (B-PFSF)), anthropometry, lipids and serum hormone levels were also assessed.

Results:

Testosterone was associated with significantly improved libido (increased B-PFSF score 5.05 points (p<0.0001)), increased total testosterone (1.3 nmol/L, p<0.0001) and free androgen index (2.0, p<0.001). Hip circumference significantly reduced (-0.74 cm, p<0.05) but there was no change in weight, body mass index, waist circumference or blood pressure.

Total cholesterol was unchanged, but there were small but significant decreases in high-density lipoprotein (HDL) cholesterol (-0.25 mmol/L, p<0.05) and lipoprotein (a) levels (-3.11mg/L , p<0.05). Fasting insulin, fasting glucose and insulin resistance were unchanged. There was no change to AIx (1.07, 95% CI -3.85-1.72, p=0.43), or RHI (0.06, 95% CI 0.19-0.31, p=0.61) but there was a significant increase in salbutamol-mediated vasodilatation (p<0.05), assessed by PWA.

Conclusion: These data suggest that short-term physiological testosterone does not adversely affect arterial stiffness and may improve markers of endothelial function. Testosterone use was associated with reductions in HDL cholesterol and lipoprotein (a), but whether this has significant long-term CV effects remains unclear.