(4) Not applicable but risk of heterogeneity was low. SR risk of bias: Low EB risk of bias: Low Authors’ conclusion: publication bias cannot be excluded, risk of bias and heterogeneity among studies are low. There is strong “Although evidence to conclude that low-dose transdermal estrogen at any dose is more effective than placebo in decreasing the daily number of moderate to severe hot flashes.” Elraiyah et al (2014)31, testosterone with or without oestrogen 35 RCTs Postmenopausal Testosterone with Placebo or Sexual function Sexual outcomes: (1)Yes. Included a (N=5053) women with or without oestrogen Frequency of sexual comprehensive normal adrenal oestrogen alone (dosage activity (SMD 0.29, 95% database search as function. (dosage varied varied per CI 0.16 to 0.41, p<0.001) well as a search for Information about per study, study, Number of satisfying unpublished data. history of breast generally it was generally it was sexual episodes (WMD (2)Yes. Quality cancer was not used: 1.25mg/day used: 1.20, 95% CI 0.88 to assessed by two provided. esterified 1.25mg/day) 1.51, p<0.001) independent estrogen and Interest in sex (SMD assessors. 2.5mg/day 0.35, 95% CI 0.19 to (3)Yes. Results methyl 0.52, <0.001) expressed as odds testosterone) Orgasm (SMD 0.20, 95% ratio or weighted CI 0.09 to 0.31, p<0.001) mean difference. Arousal (SMD 0.25, 95% (4)Yes. Statistical and CI 0.09 to 0.40, I2=77%) clinical Enjoyment of sex (SMD heterogeneity was 0.31, 95% CI 0.12 to explored. 0.51, p=0.002) SR risk of bias: Low Sexual self-image (SMD EB risk of bias: 0.20, 95% CI 0.05 to Moderate 0.35, p=0.008) Sexual responsiveness (SMD 0.29, 95% CI 0.17
(4) Not applicable but risk of heterogeneity was low. SR risk of bias: Low EB risk of bias: Low Authors’ conclusion: “Although publication bias cannot be excluded, risk of bias and heterogeneity among studies are low. There is strong evidence to conclude that low-dose transdermal estrogen at any dose is more effective than placebo in decreasing the daily number of moderate to severe hot flashes.” Elraiyah et al (2014)31, testosterone with or without oestrogen 35 RCTs (N=5053) Postmenopausal women with normal adrenal function. Information about history of breast cancer was not provided. Testosterone with or without oestrogen (dosage varied per study, generally it was used: 1.25mg/day esterified estrogen and 2.5mg/day methyl testosterone) Placebo or oestrogen alone (dosage varied per study, generally it was used: 1.25mg/day) Sexual function Sexual outcomes: Frequency of sexual activity (SMD 0.29, 95% CI 0.16 to 0.41, p<0.001) Number of satisfying sexual episodes (WMD 1.20, 95% CI 0.88 to 1.51, p<0.001) Interest in sex (SMD 0.35, 95% CI 0.19 to 0.52, <0.001) Orgasm (SMD 0.20, 95% CI 0.09 to 0.31, p<0.001) Arousal (SMD 0.25, 95% CI 0.09 to 0.40, I2=77%) Enjoyment of sex (SMD 0.31, 95% CI 0.12 to 0.51, p=0.002) Sexual self-image (SMD 0.20, 95% CI 0.05 to 0.35, p=0.008) Sexual responsiveness (SMD 0.29, 95% CI 0.17 (1)Yes. Included a comprehensive database search as well as a search for unpublished data. (2)Yes. Quality assessed by two independent assessors. (3)Yes. Results expressed as odds ratio or weighted mean difference. (4)Yes. Statistical and clinical heterogeneity was explored. SR risk of bias: Low EB risk of bias: Moderate