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> estrogen is risky for fat women

I think what you meant to say is unopposed estrogen is risky for all women.



No, I specifically was referring to fat women. Check the recommendations on birth control pills--same thing, older + fat makes them risky. The problem with the big study is that their sample was disproportionately overweight.


Unopposed estrogen (i.e. the old estrogen only HRT) is bad for women of all sizes, endometrial cancer sucks.

Separately, obesity causes higher system estrogen levels and carries the same risks.

What you may be referring to is the more recent WHI study which does have methodological flaws, but unopposed estrogen is a no-no for patients with a uterus.


It's a shame I have yet to see a microdose of testosterone included in HRT.


How can you imply a woman past menopause might possibly want sex?? And who would be willing to satisfy that desire, anyway??

Actually, it's probably a bad idea to combine them because the body's response to hormones is so variable. Keep them as separate pills so you can tweak the balance easier.


Not every post-menopausal patient will have sexual dysfunction.

Testosterone is not the only (or first line) treatment for sexual dysfunction and is off-label/not FDA approved.


What..? I don’t understand where this is coming from.

Why on earth would we give testosterone to menopausal patients?


Estrogen/progesterone and testosterone are not exclusively female/male hormones. Testosterone may boost sex drive and increase muscle mass, as well as provide some psychological benefit in women. Estrogen is the most important regulator of bone health in both men and women. There are people with estrogen insensitivity syndrome, both men and women, and from all reports they are having an extremely uncool time:

https://en.wikipedia.org/wiki/Estrogen_insensitivity_syndrom...


Yes but why on earth would testosterone be part of HRT for menopause?

The point is to replace what’s missing and causing symptoms.

Menopause =/= estrogen insensitivity.


Testosterone levels are drastically lowered in women going through menopause.


It would be part of HRT for menopause for the reasons I gave: mental health, sexual desire, muscle maintenance.

The discussion about estrogen in men is just for context. It's not unusual to talk about levels of any hormone in men or women. There's nothing "shocking" about testosterone in women, or estrogen in men.


> It would be part of HRT for menopause

I was fixating on semantics but it's not the point.

Not my area but for what it's worth UpToDate (KA Martin, RL Barbieri, JL Shifren @ MassGen Brigham) address it in expert opinion form:

> We do not suggest the routine use of androgen [testosterone] therapy for postmenopausal women. Levels of endogenous androgens do not predict sexual function for women; however, androgen therapy that increases serum concentrations to the upper limit or above the limit of normal for postmenopausal women has been shown to improve female sexual function in selected populations.

The linked out sexual dysfunction article (JL Shifren):

> In our practice, we rarely use testosterone, but will prescribe it when greatly desired by a peri- or postmenopausal patient with low libido associated with distress who has no contraindications to testosterone therapy or identifiable etiology for sexual dysfunction and is otherwise physically and psychologically healthy. Typically, the patient has already tried other safer interventions prior to the testosterone prescription, including low-dose vaginal estrogen, relationship interventions (eg, sex therapy, date nights, use of sexual aids such as vibrators, books), and adjustment of antidepressant medication (when indicated) [12]. At least one visit with a sex therapist is strongly advised prior to pharmacologic treatment, as this safe and effective intervention may make pharmacologic therapy unnecessary or enhance the response to treatment. Testosterone levels should not be used in determining the etiology of a sexual problem or in assessing efficacy of treatment, as no clear association between androgen levels and sexual function has been found in several large, well-designed studies.




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