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Differential Effects of Oral Estrogen versus Oral Estrogen-Androgen Replacement Therapy on Body Composition in Postmenopausal Women

Johns Hopkins University School of Medicine (A.S.D., T.N.), Baltimore, Maryland 21287; and Solvay Pharmaceuticals, Inc. (C.P., C.P.R.), Marietta, Georgia 30062

Address all correspondence and requests for reprints to: Adrian Sandra Dobs, M.D., M.H.S., The Johns Hopkins Hospital, 1830 Monument Street, Baltimore, Maryland 21287. E-mail: . adobs{at}jhu.edu

Abstract

Menopause is associated with decreased lean body mass and increased fat due to aging and declining hormone secretion. Estrogens or estrogen-progestins have been used to alleviate vasomotor symptoms. However, estrogen-androgen (E/A) therapy is also used for vasomotor symptom relief and has been shown to increase lean body mass while decreasing fat mass.

The objective of this 16-wk, double-blind, randomized, parallel group clinical trial was to compare esterified estrogen plus methyltestosterone (1.25 mg estrogen + 2.5 mg methyltestosterone/d; E/A group) vs. esterified estrogen alone (1.25 mg/d; E group) on body composition. Forty postmenopausal women (mean age, 57 yr) participated.

Compared with estrogen treatment alone, women in the E/A group increased their total lean body mass and reduced their percentage fat for all body parts (P < 0.05). After E/A treatment, there were statistically significant increases in lean body mass by 1.232 kg [0.181 ± 0.004, 0.81 ± 0.057, and 0.24 ± 0.009 kg in the upper body (P = 0.021), trunk (P = 0.001), and lower body (P = 0.047), respectively]. In the E group, the increase was 0.31 ± 0.004, 0.021 ± 0.03, and 0.056 ± 0.05 kg in the upper body, trunk, and lower body, respectively. In the E/A group, body fat was reduced by 0.90 kg (P = 0.18 for the trunk only), and percentage body fat declined by 7.4% (P 0.05 for all body parts). Lower body strength increased by 23.1 kg (51 lb) in the E/A group vs. only 11 kg (24.25 lb) in the E group (P = 0.002 between groups). A statistically significant increase in weight (2.7 ± 5.1 vs. 0.1 ± 4.6 lb; P < 0.05) was observed in the E/A group compared with the E group. When subjects were given self-reporting questionnaires, more improvement was noted in sexual functioning and quality of life in the E/A group when compared with patients receiving E alone. There were no noteworthy side effects.

In conclusion, E/A replacement therapy can improve body composition, lower-body muscle strength, quality of life, and sexual functioning in postmenopausal women.

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