Wk.10 L2 - Hormone replacement therapy

Question 1

LO

Answer 1

1. Describe factors that may influence the effects of HRT
2. Explain the benefits of HRT on bone and muscle health as well as osteoarthritis in various populations

Question 2

Steroid hormone production

Answer 2

Male and female gonads release sex steroid hormones (testosterone and estradiol)

They bind to steroid receptors:
- nuclear (slow responses)
- membrane (fast responses)

Question 3

Hormone deprivation

Answer 3

• Both androgen and estrogen receptors are muscles and bones
• Hormone deprivation reduces bioavailability of ligands to bind to the receptors
• Androgen and estrogen deprivation increase the risks of osteroporosis and sarcopenia (fractures risk)
• There are other side effects as well

Question 4

Hormone replacement therapy

Answer 4

Need to consider:
- Doses
- Duration
- Type of agents
- Route of administration
- Side effect monitoring
- Onset of treatment, in relation to the start
of hormone deprivation

Eg.
Estrogens treatment to post-menopausal women, and men on androgen-deprivation

Testosterone treatment to men with hypogonadism due to natural cause or medical treatment

Question 5

Women’s Health Initiative

Answer 5

• First large-scale study on HRT effects on CHD
• Postmenopausal women received CEE, with or without MPA.
• Stopped in 2004 due to elevated risks of coronary events, despite reducing fractures.
• Starting HRT early around menopause appearsmto have benefits

Question 6

Estrogen treatment in men

Answer 6

• Hepatic metabolism of oral estrogens increases clotting factor, increasing thromboembolism risks
• Non-oral estrogens have similar cardiovascular risks as LHRH agonists in prostate cancer patients

Question 7

HRT on bone health

Answer 7

• reduces the risk of bone fractures in post-menopausal women
• Estradiol in men mainly comes from testosterone conversion
• Transdermal estradiol treatment preserves bone mineral density in androgen-deprived men
• Estradiol treatment reduces fracture risk in androgen-deprived men

Question 8

HRT on muscle health

Answer 8

HRT does NOT improve lean muscle mass in postmenopausal women, but does improve strength

Question 9

Testosterone replacement therapy

Answer 9

• Increases muscle mass in middle-aged and older men
• More effective with intramuscular injection
• Increases muscle strength in older hypogonadal men.

Question 10

Impact of HRT on osteoarthritis

Answer 10

The effects of HRT on osteoarthritis in post-menopausal women is inconclusive