Generic Name for Estrogen-Methyltestosterone Combination
The generic name is esterified estrogens-methyltestosterone (or conjugated esterified estrogens-methyltestosterone).
Product Details
The most commonly recognized brand name for this combination is Estratest (full strength) and Estratest HS (half-strength), which contain:
- Full strength (Estratest): 1.25 mg esterified estrogens + 2.5 mg methyltestosterone
- Half strength (Estratest HS): 0.625 mg esterified estrogens + 1.25 mg methyltestosterone 1
Recent formulations have also included lower doses (0.30 mg esterified estrogens + 0.30 mg methyltestosterone) 2.
Clinical Context and Important Safety Considerations
While this combination has been marketed since 1964 for moderate-to-severe vasomotor symptoms in patients whose symptoms have not been relieved by estrogens alone 1, current evidence raises significant concerns about breast cancer risk that must be weighed carefully.
Breast Cancer Risk Profile
The evidence regarding breast cancer risk is concerning but somewhat mixed:
The Nurses' Health Study found a significantly elevated risk: Current users of estrogen plus methyltestosterone had a relative risk of 2.48 (95% CI, 1.53-4.0) for breast cancer compared to never-users, which was notably higher than estrogen alone or estrogen-progestin combinations (RR 1.23) 3
The WHI Observational Study showed more modest findings: An adjusted hazard ratio of 1.42 (95% CI, 0.95-2.11) that did not reach statistical significance, though Estratest specifically showed HR 1.78 (95% CI, 1.05-3.01) 4
A larger WHI analysis found no significant association: HR 1.06 (95% CI 0.82-1.36) for any CEE+MT use and HR 1.22 (95% CI 0.78-1.92) for exclusive use 5
Current Clinical Standing
This combination is rarely recommended in contemporary practice because:
- Standard menopausal hormone therapy guidelines 6, 7 do not include testosterone combinations as first-line therapy
- The FDA-approved indications for menopausal hormone therapy focus on estrogen alone or estrogen-progestin combinations
- More recent androgen therapy guidelines 3 emphasize transdermal testosterone preparations over oral methyltestosterone when androgen supplementation is indicated
When This Combination Might Be Considered
If prescribed, it should only be for postmenopausal women with:
- Moderate-to-severe vasomotor symptoms inadequately controlled by estrogen alone
- No contraindications to hormone therapy (see standard MHT contraindications 6, 7)
- Enhanced breast cancer surveillance given the potential elevated risk
- Understanding that this is not a guideline-recommended first-line approach
The lowest effective dose should be used (0.30 mg/0.30 mg combination demonstrated efficacy) 2, and duration should be limited consistent with general MHT principles.