Oral estrogen, unlike transdermal estrogen, increases the level of sex-binding globulin hormone, which reduces the free testosterone in women and thus may reduce libido (Item 138-6). If a patient has reduced libido on oral estrogen, a transdermal product should correct the problem.—G.M. Rehert, MD, Atlanta

The differences between transdermal and oral preparations notwithstanding, a set of clinical trials in more than 27,000 postmenopausal women (the Women’s Health Initiative) found that systemic estrogen therapy did not improve sexual satisfaction and may even be harmful.—Reuben W. Zimmerman, PA-C (140-15)

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