Other positive effects of androgens include effects on mood, memory, sexual functioning, and sense of well-being. While estrogen alone may improve sexual functioning, progestins with androgenic properties also have been shown to have positive effects in this regard. The resurgence of symptoms that occurs with the addition of MPA is not surprising given the fact that this particular progestin is such a potent downregulator of the estrogen receptor. As a consequence of this effect, much of what can be accomplished with ERT may be offset by the addition of this progestin. Thus, a progestin derived from testosterone may provide a more balanced effect due to its relative androgenic properties.
Androgenic replacement is particularly important for relief of postmenopausal sexual dysfunction.
While concern about cancer and adverse effects such as bleeding certainly play a large role in treatment discontinuation, our group has found that a key reason that women discontinue HRT is the lack of understanding of its beneficial effects. This is a situation that is easily ameliorated. Allowing sufficient time during first appointments is crucial because this is the point at which the therapeutic alliance will be formed. If the healthcare provider is able to respond in a meaningful way during this appointment and demonstrate a willingness to work collaboratively and take a true team approach to treatment, continuation rates will tend to be far higher. In addition, evaluation must precede the writing of a prescription, and monitoring, counseling, and education should be provided regularly and often.