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A safe and effective alternative to estrogen therapy
Volume Number
127 8
A safe and effective alternative estrogen therapy
Correspondence
to
To thr Editon: The current controversy regarding the safety of long-term estrogenic therapy prompts me to draw attention to alternative treatment that is safe and effective. It must be emphasized that the complications being reported with estrogen treatment are frequently dose-related and could be prevented by tapering off initial dosage to that of the minimal effective dose. This objective can only be attained by close supervision of the patient and by use of all of the modalities to guide one as to what can be the minimal dose. Women manifest highly variable subjective and ob.jective responses to estrogenic therapy because the ovaries continue to secrete some estrogen during the climacterium. Pretreatment vaginal cytology will reveal the extent of secretion. In the presence of continued ovarian function. little or no estrogen is required. Our’ clinical trials in 1943 with Premarin gave us very satisfactory results with very conservative dosage. However, the occasional functional uterine bleeding and/or mastalgia prompted me to investigate an alternative treatment, that is, combining small doses of estrogen and testosterone in one tablet. Two clinical trials with such a combined tablet gave very gratifying results without any significant side reactions.‘, 3 One of these, a double-blind study, was reported to the American Medical Association in 1950. The rationale for combining small doses of estrogen and testosterone may be summarized as follows: 1. Since women, as well as men, secrete both androgens and estrogen, treatment with both hormones may provide a more balanced physiologic replacement therapy for both the menopause syndrome and senile osteoporosis. 2. The small dose of testosterone permits a sharp reduction in the dose of estrogen, thus canceling out the undesired stimulation of the breasts and uterus. 3. The anabolic synergism inherent in the combined hormone therapy imparts a truly tonic sense of wellbeing. Even the psychoneurotic patients respond more favorably. Thus, relatively superficial psychotherapy becomes more effective in those patients who require more than hormones for relief. 4. The hormone combination provides a synergistic suppression of the overactive gonadotropic function of the pituitary while affording the patient positive symptomatic relief. 5. Since testosterone improves the sexual response in women, treatment with the combined hormones should impart some reassurance that the aging woman is not failing in her psychosexual life, Following the report to the American Medical Association, a number of products combining estrogen and testosterone appeared on the market. Unhappily,
895
some of these preparations were heavily weighted with one or both hormones. Consequently, some susceptible women developed hypertrichosis or acne or gained some weight. These complications threw this desirable therapeutic modality into disfavor. However, our studies with an oral* and a buccalf tablet demonstrated excellent therapeutic responses without any of the above complications. Of course, the dosage in these tablets was more conservative. Our objective at all times was to provide relief with the minimal effective dose and thereby obviate the undesired complications. This precaution is particularly applicable to the management of long-term treatment of the climacteric, senile osteoporosis. and those aging women who aspire to remain as feminine as possible. Buccal tablets? of estrogen and testosterone may have significant advantages over those ingested orally. Like nitroglycerin, the buccal hormone tablets provide prompt systemic absorption and thereby exert beneficial hormonal effects before being inactivated by the liver. These particular buccal tablets lend themselves to long-term therapy because of their conservative dosage. The eternal quest for the fountain of youth is as illusory today as it was in the days of Ponce de Leon. But the pursuit of “femininity forever” has borne some fruit in recent times. To supplement waning ovarian function with low-dosage combined hormones is rational replacement therapy for the aging woman. The anabolic hormonal stimulus cannot impart eternal youthfulness, but it can ameliorate some of the ravages of the aging process. Continued treatment with a maintenance dose does provide a sense of well-being not attainable with any other therapy. Even though the published data of the clinical trials with combined estrogen-androgen treatment are not recent, subsequent experience with such therapy has been uniformly gratifying. Those of us who have had long experience with this combined treatment are convinced that it is a perfect alternative to estrogen therapy for the climacteric or aging women. S. J. Gios~. M.D. 360 North Bedford Driw Brverly Hills, California 902 IO *Tylosterone and Tylandril, Eli Lilly & Co. tTest-Estrin buccal tablets, Marlyn Company. Inc. REFERENCES
1. Glass, S. J., and Rosenblum, G.: Therapy of the menopause, J. Clin. Endocrinol. Metab. 3: 95, 1943. 2. Glass, S. J.: Advantages of combining oral androgen with estrogens in treatment of the menopause. Ann. West. Med. Surg. 3: 186, 1949. 3. Glass, S. J., and Shapiro, M. R.: Androgen-estrogen treatment of the menopause, G. P. 3: 39, 1951.
127 8
A safe and effective alternative estrogen therapy
Correspondence
to
To thr Editon: The current controversy regarding the safety of long-term estrogenic therapy prompts me to draw attention to alternative treatment that is safe and effective. It must be emphasized that the complications being reported with estrogen treatment are frequently dose-related and could be prevented by tapering off initial dosage to that of the minimal effective dose. This objective can only be attained by close supervision of the patient and by use of all of the modalities to guide one as to what can be the minimal dose. Women manifest highly variable subjective and ob.jective responses to estrogenic therapy because the ovaries continue to secrete some estrogen during the climacterium. Pretreatment vaginal cytology will reveal the extent of secretion. In the presence of continued ovarian function. little or no estrogen is required. Our’ clinical trials in 1943 with Premarin gave us very satisfactory results with very conservative dosage. However, the occasional functional uterine bleeding and/or mastalgia prompted me to investigate an alternative treatment, that is, combining small doses of estrogen and testosterone in one tablet. Two clinical trials with such a combined tablet gave very gratifying results without any significant side reactions.‘, 3 One of these, a double-blind study, was reported to the American Medical Association in 1950. The rationale for combining small doses of estrogen and testosterone may be summarized as follows: 1. Since women, as well as men, secrete both androgens and estrogen, treatment with both hormones may provide a more balanced physiologic replacement therapy for both the menopause syndrome and senile osteoporosis. 2. The small dose of testosterone permits a sharp reduction in the dose of estrogen, thus canceling out the undesired stimulation of the breasts and uterus. 3. The anabolic synergism inherent in the combined hormone therapy imparts a truly tonic sense of wellbeing. Even the psychoneurotic patients respond more favorably. Thus, relatively superficial psychotherapy becomes more effective in those patients who require more than hormones for relief. 4. The hormone combination provides a synergistic suppression of the overactive gonadotropic function of the pituitary while affording the patient positive symptomatic relief. 5. Since testosterone improves the sexual response in women, treatment with the combined hormones should impart some reassurance that the aging woman is not failing in her psychosexual life, Following the report to the American Medical Association, a number of products combining estrogen and testosterone appeared on the market. Unhappily,
895
some of these preparations were heavily weighted with one or both hormones. Consequently, some susceptible women developed hypertrichosis or acne or gained some weight. These complications threw this desirable therapeutic modality into disfavor. However, our studies with an oral* and a buccalf tablet demonstrated excellent therapeutic responses without any of the above complications. Of course, the dosage in these tablets was more conservative. Our objective at all times was to provide relief with the minimal effective dose and thereby obviate the undesired complications. This precaution is particularly applicable to the management of long-term treatment of the climacteric, senile osteoporosis. and those aging women who aspire to remain as feminine as possible. Buccal tablets? of estrogen and testosterone may have significant advantages over those ingested orally. Like nitroglycerin, the buccal hormone tablets provide prompt systemic absorption and thereby exert beneficial hormonal effects before being inactivated by the liver. These particular buccal tablets lend themselves to long-term therapy because of their conservative dosage. The eternal quest for the fountain of youth is as illusory today as it was in the days of Ponce de Leon. But the pursuit of “femininity forever” has borne some fruit in recent times. To supplement waning ovarian function with low-dosage combined hormones is rational replacement therapy for the aging woman. The anabolic hormonal stimulus cannot impart eternal youthfulness, but it can ameliorate some of the ravages of the aging process. Continued treatment with a maintenance dose does provide a sense of well-being not attainable with any other therapy. Even though the published data of the clinical trials with combined estrogen-androgen treatment are not recent, subsequent experience with such therapy has been uniformly gratifying. Those of us who have had long experience with this combined treatment are convinced that it is a perfect alternative to estrogen therapy for the climacteric or aging women. S. J. Gios~. M.D. 360 North Bedford Driw Brverly Hills, California 902 IO *Tylosterone and Tylandril, Eli Lilly & Co. tTest-Estrin buccal tablets, Marlyn Company. Inc. REFERENCES
1. Glass, S. J., and Rosenblum, G.: Therapy of the menopause, J. Clin. Endocrinol. Metab. 3: 95, 1943. 2. Glass, S. J.: Advantages of combining oral androgen with estrogens in treatment of the menopause. Ann. West. Med. Surg. 3: 186, 1949. 3. Glass, S. J., and Shapiro, M. R.: Androgen-estrogen treatment of the menopause, G. P. 3: 39, 1951.