Effects of androgen supplementation of hormone replacement therapy on the vascular reactivity of cerebral arteries

Objective: To determine the effect of the androgen supplementation of hormone replacement therapy (HRT) on the vascular reactivity of cerebral arteries. Design: Open randomized study. Setting: Healthy volunteers in an academic research environment. Patient(s): Forty postmenopausal women who were treated with sequential HRT (transdermal E₂ 50 μg/d + medroxyprogesterone acetate 10 mg/d for 12 days every other month) for ≥1 year and ≤5 years. Intervention(s): Testosterone undecanoate (40 mg/d, p.o.) was randomly administered to 20 patients during ongoing HRT; the other 20 served as controls. Doppler evaluations of the internal carotid and middle cerebral arteries were performed together with lipid levels assessments. A visual analogue scale (VAS) was used to evaluate various parameters relating to sexual life and well-being. Main Outcome Measure(s): Pulsatility index (PI) of the arteries, VAS assessment of psychophysical well-being. Result(s): The administration of testosterone undecanoate during HRT induced an increase in the PI of the middle cerebral artery and a reduction of high-density lipoprotein cholesterol. Sexual desire and satisfaction were greatly improved. Conclusion(s): In postmenopausal women, androgen supplementation during HRT can partially counteract the beneficial effects of estrogens on cerebral vascular reactivity and lipid profiles, but sexual desire and satisfaction are greatly improved.