Estrogen/androgen Combination (Oral, Parenteral)

Most commonly used for the treatment of symptoms associated with menopause, estrogen-androgen combination supplies the body with hormones it is missing after menopause.

Overview

Estrogen and androgen hormones are produced by both males and females, and for females estrogen has a strong influence on sexual development and on the menstrual cycle, once it begins. While androgens are also present in females, it is in much smaller amounts than in males, and in males the androgens have a similar influence over sexual development.

As a female reaches menopause and the end of child-bearing years, both these hormones are produced in lower amounts by the body, and as a result, some mild to severe side effects begin appearing. It is common during this time for a female to experience chills and sweating, dizziness, hot flashes, and faintness. To counteract these sensations, estrogen-androgen combination is often prescribed to make up the difference of the lower hormonal production.

While there is no solid medical or scientific evidence to support this, there is a fairly popular belief that this combination medicine can also help females retain a more youthful appearance, by smoothing out wrinkles and softening or lubricating the skin. This belief has grown because the medication does seem to have the effect of delaying or countering the effects of menopause and middle age, but the scientific basis is lacking for this belief.

There are two primary routes for this combination medication to be administered to a patient, orally and parenterally, which is by intravenous injection. The most common brand names by which estrogen-androgen combination medicine is marketed in the U.S. are: Covaryx, Essian, Estratest, Menogen, and Syntest.

Condition Treated

  • Symptoms associated with the onset of menopause

Type Of Medicine

  • Hormonal supplement

Side Effects

In addition to the beneficial effects of managing symptoms of menopause, estrogen/androgen medication may also impart some unwanted side effects to a patient being treated. Although it is extremely rare, it is possible for this medication to cause tumors of the liver as well as various liver diseases which can be life-threatening.

Females who take androgens in higher doses may experience the development of masculine changes, such as a deeper voice or hoarseness in the voice, unusual and excessive growth of hair, or in some cases, hair loss. While most of these undesirable side effects will fade away once the androgens are no longer being taken, there are some changes such as a deeper voice, which may never go away.

It has been reported that a prolonged usage of estrogens can elevate the risk of endometrial cancer following menopause. When low doses of estrogens are used and for less than a year, there seems to be a correspondingly low risk of such developments. However, as the dosage increases and the duration of treatment is prolonged, that risk seems to elevate. The risk of developing endometrial cancer is significantly diminished when a female takes progestin in addition to estrogen as part of the treatment program. Also, if a woman has had a total hysterectomy, there is no danger at all of endometrial cancer.

Although studies appear to indicate an increased risk of breast cancer when taking strong doses of estrogen, it is not known for certain whether or not there is a correlation between the two.

Some of the more uncommon side effects associated with taking estrogen/androgen combination medication include the following:

  • Jerky muscle movements which are uncontrollable
  • Vomiting up of blood
  • Confusion or disorientation
  • Unusual tiredness or drowsiness
  • Unexplained bleeding
  • Flushing of the skin or redness appearing on the skin
  • Persistent headaches
  • Hives appearing at the site of an injection
  • Unexplained shortness of breath
  • Skin rashes or itching

There is a much higher incidence of the side effects reported below by patients, and these are also serious enough that they should be reported to your doctor at the earliest opportunity:

  • Tenderness or pain in the breasts
  • Oily skin or severe acne
  • Rapid and unexplained weight gain
  • Unusual loss of hair
  • Swelling in the feet, ankles, or lower legs
  • Increase or decrease in the size of the breasts
  • Enlarged clitoris
  • Unnatural growth of hair
  • Changes in menstrual activity such as complete cessation of bleeding, heavier than normal bleeding, unusually prolonged bleeding, breakthrough bleeding, more spotting than usual.

When a patient takes estrogen/androgen combination over a prolonged period of time, it is more likely that some of the following side effects will appear. These are also considered to be fairly severe in nature, and should therefore be reported to your doctor at their first appearance:

  • Dark-colored urine
  • Severe nausea and vomiting
  • Persistent unpleasant odor on the breath
  • Spots that are red or purple in color and appear inside the mouth or nose, or elsewhere on the body
  • Lumps in the breasts
  • Discharge from the breasts
  • Tarry or black-colored stools
  • Persistent feeling of general discomfort
  • Frequent appearance of hives
  • Sore throat or fever
  • Tenderness, pain, or swelling in the upper abdomen or stomach
  • Loss of appetite

You may also experience some relatively minor side effects that come and go while being treated with estrogen/androgen combination medication. These occur commonly as the body adjusts itself to the medication, and in most cases, will subside all on their own without any kind of medical treatment.

Dosage

The dosage used for estrogen/androgen medication will be different from patient to patient, but in all cases, only the amount and duration prescribed by your doctor should be used. It is most beneficial to the patient if the medication is taken at the same time every day so that the dosage can be remembered more easily, and so the body can become used to the medication.

It is fairly normal for nausea to occur in patients during the first few weeks of treatment with estrogen. If nausea persists beyond those first few weeks, it may be helpful to have a meal at the same time as taking your estrogen/androgen combination medication to alleviate nausea.

The dosages listed below are not to be considered recommendations for any individual patient, but are instead standard dosages which are often used as an initial treatment, and can then be adjusted upward or downward for a specific patient. It should be remembered that the amount of medication that a doctor will prescribe for you will depend on several factors, including the strength of the medicine, the number of dosages that you will be taking each day, the elapsed time between dosages, the overall duration of your treatment, and the specific medical condition for which you are being treated.

For those patients being treated with oral tablets:

  • Dosage level assumes that the medical condition being treated is for menopausal symptoms such as faintness, dizziness, unusual sweating, chills, or hot flashes
  • An adult dosage between 0.625 and 2.5 mg of esterified estrogen and 1.25 mg of methytestosterone once each day for a period of three weeks
  • Treatment should be halted for one week
  • Resumption of treatment should begin with another 21-day cycle.

For patients being treated via injection for menopause:

  • Dosage level assumes that the medical condition being treated is for symptomatic menopause, including side effects of chills, unusual sweating, dizziness or faintness, and hot flashes
  • Adult dosage of 50 mg of testosterone cypionate, 2 mg of estradiol cypionate, injected every four weeks directly into muscle
  • An alternative dosage of 90 mg of testosterone enanthate, 4 mg of estradiol valerate, injected every four weeks directly into a muscle.

For patients being treated via injection for osteoporosis:

  • Dosage level assumes treatment for bone loss (osteoporosis)
  • Adult dosage of 150 mg of testosterone enanthate benzillic acid hydrazone, 7.5 mg of estradiol dienanthate, 1 mg of estradiol benzoate, injected directly into a muscle every 4 to 8 weeks.

If you should miss a dosage of your medication, take it as soon as you do remember, unless you are nearing the time of the next regularly scheduled dosage. In this situation, it's better to skip the missed dosage entirely, and just wait for the next regularly scheduled dosage. It is never advisable to double up on dosages simply to catch up on your treatment schedule.

Interactions

There is a possibility that using estrogen/androgen combination medicine with other medications can produce unwanted side effects that should be avoided. For this reason, it will be highly beneficial for you to prepare a list of all medications you are currently taking, so that your doctor can review this list and make a determination about any possible interactions. This list should include all other prescription medications which you are taking, as well as over-the-counter drugs, vitamins, and herbal supplements, as well as all of the dosages of each.

This will be an important list to have on hand if you should have a need to visit an emergency clinic for treatment of an unexpected medical condition. Since your primary care doctor will not be at this emergency room, you will need to provide the doctor in residence with this list, so he/she can also avoid prescribing medications which interact with those you are currently taking.

While being treated with estrogen/androgen combination medicine, you should not take any other medications which include tranexamic acid. A second class of medications listed below should be considered drugs to be avoided unless there is some urgent reason for keeping them in your program of treatment.

  • Tizanidine
  • Theophylline
  • Anisindione
  • Bupropriol
  • Carbamazepine
  • Phenprocoumon
  • Donepezil
  • Dasabuvir
  • Darunavir
  • Dicumarol
  • Eliglustat
  • Isotretinoin.

It is also not advisable to take estrogen/androgen combination medicine when any of the following medical conditions are in your personal history:

  • Gallstones or any history of gallbladder disease
  • Endometriosis
  • Jaundice
  • Liver disease or any kind of liver problems
  • Blood clots
  • Type II diabetes mellitus
  • Heart disease
  • Circulatory diseases
  • Kidney disease
  • Porphyria
  • Uterine fibroid tumors
  • Breast cancer, whether active or suspected
  • Any kind of significant changes in vaginal bleeding
  • Swelling of the feet, ankles, or lower legs

Warnings

There are a few precautions which should be taken by patients being treated with estrogen/androgen combination medicine, so as not to cause new medical problems or exacerbate the existing ones. One of the most important precautions to observe is ensuring that you are not allergic to this medication in any way, and that it does not trigger any other allergies which you may have.

If you are allergic to pets, fabrics, preservatives or certain food substances, you should alert your doctor to this fact, so that he/she is aware there's a potential for some kind of allergic reaction. Also, if you know that you are allergic to this medication or any components used to make it, you should point that out to your doctor before any program of treatment begins.

Some of the most noticeable symptoms to look for from someone who may be experiencing an allergic reaction are the following:

  • Persistent itching at various locations around the body
  • Pronounced dizziness or lightheadedness, possibly including confusion and disorientation
  • Hives and/or rashes appearing on the skin
  • Pronounced swelling, mostly in the area around the face and in the lips, mouth, and throat.

If you are self-administering the injectable form of estrogen/androgen medication, be sure that you thoroughly understand the procedure from your doctor or medical professional. If there is anything which you do not understand or do not remember, make sure to receive explicit instruction from a knowledgeable professional before attempting to administer the medication yourself. This includes having a good understanding of how to use and dispose of needles and other materials used in the self-administration process. Consult with your doctor about how to handle any expired or unused medication, so that you do not cause a danger to others when discarding unwanted medication.

It is unknown whether or not estrogen/androgen medication elevates the risk of breast cancer in females, and that makes it very important that you regularly check your breasts for any unusual signs of discharge or lumps which were not apparent before. Your doctor may also want to periodically have you undergo a mammogram, to be sure that no lumps are developing in the breasts.

For some patients, there is a potential for swelling, tenderness, or bleeding of the gums to develop, and this makes it even more important that you take all appropriate steps to floss your teeth, brush faithfully, and at every opportunity, to even massage your gums to counteract any symptoms affecting your gums. While being treated with estrogen/androgen medicine, make sure to keep all dental appointments and have your teeth cleaned regularly. At your dental appointments, make sure to apprise your dentist of any kind of gum problems which may have been occurring during your program of treatment. He/she will be able to instruct you about any steps which can be taken to alleviate problems with gums.

Estrogen/androgen combination medicine may affect diabetic patients by elevating blood sugar levels. If you do self-monitoring at home and notice any changes in blood sugar levels, or if you have been checked at a laboratory and they found elevated levels, you should notify your doctor immediately. It may be necessary to alter your dosage or to discontinue usage of estrogen/androgen combination medicine if you are diabetic.

Some studies have shown that it can be dangerous to concurrently be treated with estrogens while also smoking cigarettes, especially as it impacts the heart. An increased incidence of dangerous blood clots, heart attacks, strokes, and problems with the circulatory system were identified in these studies. It was also noticed that the risk was much more significant in women aged 35 and above who smoked while also taking oral contraceptives including estrogens. In all cases, the risk became much greater as the age of the smoker and the amount of smoking increased.

This medication should not be shared with anyone else nor given to anyone else, even if they are experiencing the same exact symptoms which you are being treated for. The medication and the precise dosage have been customized for you personally, and should not be given to anyone else. Part of the reason for this is that everyone's body reacts differently to medications, and there is no way of knowing how someone else's body may react to a medication which has been prescribed for you. If a person you give your medication to were to develop severe side effects or symptoms as a result, you would have been partly responsible for that happening.

It is strongly recommended that you do not take estrogen/androgen combination medicine if you are pregnant or thinking of becoming pregnant. Some estrogens have been found to be harmful for unborn fetuses in that they cause significant birth defects, and this fact alone makes it much too dangerous to continue treatment with this medicine during pregnancy. It has also been reported that some females who have taken estrogens during pregnancy developed problems with the reproductive system, and in a few rare cases, also cancer of the vagina or uterine cervix.

Some of the male offspring of women who took estrogens during pregnancy have also developed urinary tract problems during adolescence or adulthood. It is also highly inadvisable for woman to be treated with any kind of androgens during pregnancy, since this may impart masculine traits in a female baby, and these are generally not reversible.

It is known that estrogens and androgens are passed on to an infant through breast milk, so mothers who intend to breastfeed should not be taking any hormonal supplements like these while nursing. There is a potential for early sexual development in males, and masculine development for female babies, when androgens are passed on to infants through breastfeeding. The bottom line is, it is simply not worth the risk to your infant to be taking androgens or estrogens while nursing.

Storage

Whether you have the tablet form of estrogen/androgen combination medicine, or the injectable, it should be stored at room temperature, away from direct lighting and away from any extremes of temperature. It is not recommended to store this medication in the bathroom, since that area is frequently subject to excessive humidity during periods of bathing and showering. It should also be kept out of the reach of any pets or children in the household, since ingestion could be dangerous for them. If you are self-injecting at home, all needles and other materials should be kept away from anyone else who might accidentally access them and create a dangerous situation.

When you need to discard unused or expired medication, do not flush down a sink or toilet, but follow proper disposal methods as recommended by your doctor or pharmacist. If necessary, you can also find out about proper disposal on the FDA website for safe disposal of medicines.

Summary

Estrogen/androgen combination medicine is most often used by female patients who wish to alleviate the symptoms of menopause, usually chills, hot flashes, dizziness, and others. The medication itself is comprised of hormonal supplements that help to make up for a deficiency of hormone production which generally happens at menopause. The medication is available in tablet form, and in an injectable form, and the one which is better suited to your personal needs will be determined by your doctor.

There are a number of precautions which must be taken into account by patients considering treatment with estrogen/androgen medication, including the possibility of passing on unwanted characteristics to infants by pregnant mothers. This makes it highly inadvisable for women who are pregnant or may become pregnant to take this medication, especially since it can also be passed on in breast milk.

Although estrogen contributes strongly to the development of the female reproductive system, there is no strong evidence which supports the fact that it helps to keep a woman younger in appearance, as some people have thought in the past.