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  • Title: Changes in lipoproteins with various sex steroids.
    Author: Teran AZ, Greenblatt RB, Chaddha JS.
    Journal: Obstet Gynecol Clin North Am; 1987 Mar; 14(1):107-19. PubMed ID: 3306515.
    Abstract:
    Menopausal symptoms are a consequence of the decline in sex hormone production, and hormone replacement therapy aims not only to relieve these symptoms but also to prevent the development of diseases of old age such as osteoporosis. The general opinion taken from a wide variety of publications is that the serum lipid concentrations change during hormone replacement therapy with estrogen, progesterone, and testosterone, or when oral contraceptives are administered. The intolerance of many women to oral contraceptives and the many side effects developed from the birth control pill lead us to suggest that pure crystalline estrogen pellets for subcutaneous implantation are an excellent method of contraception, adding beneficial influence upon lipid metabolism by increasing HDL concentration. The use of progestogens (nortestosterone or hydroxysteroid derivatives) in order to induce withdrawal periods and to avoid endometrial hyperplasia is recommended. But it is important to note that the nortestosterone derivatives (norgestrel and norethindrone acetate) differ markedly from the nonadrogenic 17-alpha hydroxyprogesterone derivative in that the former lowers HDL levels noticeably more than the latter. In a series of studies investigating the effects of natural and synthetic sex steroids, given by various routes, on lipoproteins in men and women, this review emphasizes subcutaneous pellet administration of natural testosterone and estradiol. It has been reported over the years that oral contraceptives increase cholesterol and triglycerides, and decrease HDL and LDL. Age alone seems to be the determining factor causing coronary heart disease in women, due to low endogenous estrogens. HDL and LDL, a remnant of the VLDL lipoprotein, are implicated atherogenesis. In 191 men treated with pure crystalline testosterone pellets, 75 mg per 10-20 pounds body weight per 6 months, there was a small, but significant increase in HDL, and a decrease in cholesterol: HDL ratio and LDL: HDL ratios at 6 and 12 months. No significant differences were recorded after 2 to 10 years. In 91 women implanted with estradiol pellets for contraception, and given oral progestins from Day 16-25, the effects on lipoproteins depended on the specific progestin used. Norethindrone acetate 5 mg decreased HDL at 6 months, but not at 12 months. Norgestrel 0.0075 mg decreased VLDL at 6 and 12 months, but did not affect HDL or LDL. Medroxyprogesterone acetate, 10 mg did not change lipoproteins significantly. Estradiol pellets alone did not alter lipids in 46 postmenopausal women. Gn-RH or its agonist danazol effectively blocked pituitary function in 17 women with endometriosis, and raised LDL significantly.
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