Osteoporosis testosterone therapy

Middle-aged women with somatic and mood symptoms shonld undergo evaluation for perimenopansal depression. Transdermal 17/3-estradiol replacement can rednce vasomotor symptoms significantly improve mood, sleep, and cognition and decrease the risk of osteoporosis. " Transdermal testosterone therapy has been shown to improve mood, well-being, and sexnal fnnctioning in perimenopansal women. ... 

The ability of androgens to counter osteoporosis is the basis of their use as a supplement to estrogens in one version of hormone replacement therapy. Testosterone can increase markers of bone formation (66). However, the early closure of epiphyses, with an arrest of growth, is a risk if children are exposed to these substances this latter effect may be produced by the estrogen to which testosterone is metabolized. In some patients with... 

Normal endometrial tissues are devoid of aromatase activity. In patients with endometriosis, evidence suggests that high levels of aromatase are present in endometrial implants. Aromatase is the enzyme that catalyzes the conversion of androstenedione and testosterone to estrone and estradiol, respectively (Fig. 46.3). If an aromatase inhibitor, such as anastrozole (Fig. 46.11), is administered, then estrogen production will be decreased in the endometrial implants. A local state of estrogen deficiency will prevent growth of these implants (84). Unfortunately, one outcome of prolonged aromatase therapy is the development of osteoporosis. As a result, an OC typically is coadministered to provide baseline estrogen concentrations and limit the risk of osteoporosis. 

The process of deposition of calcium in bone is not fully understood, but alkaline phosphatase, vitamin D, vitamin C, and probably other factors are of great importance. Removal of mineral from bone and maintenance of normal serum calcium concentration is dependent largely on the activity of the parathyroid hormone. Albright considers that the primary effect of the parathyroid hormone is an increase in phosphorus excretion (Chapter 21). This is followed by a decrease in serum phosphorus and resorption of phosphorus and calcium from bone. Other hormones also influence utilization of calcium and phosphorus (Chapter 21). In hyperthyroidism, excretion of calcium and phosphorus is increased and osteoporosis may develop. The steroid hormones, e.g., estradiol and testosterone, decrease calcium and phosphorus excretion and may therefore be useful in the therapy of postmenopausal and senile osteoporosis. 

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