Estrogen vs. androgen in hormone-replacement therapy for complete androgen insensitivity syndrome

German researchers endeavored to restore quality of life and sexual satisfaction in women who underwent gonadectomy but then developed complete androgen insensitivity syndrome (CAIS).

German researchers endeavored to restore quality of life and sexual satisfaction in women who underwent gonadectomy but then developed complete androgen insensitivity syndrome (CAIS). Participants were randomized to receive 6 months of hormone-replacement therapy with either estradiol or testosterone, before crossing over to the alternate treatment for an additional 6 months. Of the 26 female patients aged 18–54 years who were initially enrolled, 18 were included in the final analysis. The primary outcome was mental health-related quality of life, while secondary outcomes included psychological well-being, sexual function, and somatic effects. Mental health-related quality of life and psychological well-being scores were comparable between the two treatment groups, as were positive symptom distress and positive symptom total. Testosterone, however, was superior to estradiol in improving sexual desire. Adverse events occurred more frequently, meanwhile, with patients receiving testosterone—but most were low grade. Thus, the investigators conclude that testosterone is as safe and well tolerated as estrogen for hormone-replacement therapy and can be used to treat CAIS, especially in women whose sexual function is compromised.