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The 9th World Congress on the Menopause Yokohama, Japan, 17–21 October 1999

First, non-steroidal oestrogens, and now non-steroidal androgens. Last year Dalton and colleagues from the University of Tennessee reported that they had identified a compound which, for the moment, we may call an ARM (androgen receptor modulator) which binds to the androgen receptor (AR) which, like the oestrogen receptor, resides in the nucleus of cells and is a member of the steroid receptor superfamily. 1The ARM not only locked on to the AR with the same affinity as its natural ligand, dihydrotestosterone, but also proceeded to activate the transcription of androgen sensitive genes. This is a major advance and immediately recalls recent events which led to the identification, testing and now prescribing of the selective oestrogen receptor modulator raloxifene as an inhibitor of bone loss and, potentially, breast cancer. The future use of ARM therapy is likely to fall into two therapeutic areas: male infertility, and male and female hormone replacement. With reference to the latter, it has long been known that many women complain of tiredness and loss of libido after natural or surgical menopause. Androgen is also known to stimulate bone formation. At present androgen replacement, where available, is given six-monthly as a testosterone implant. This can cause androgenic side effects and the potential of a non-steroidal ARM delivered orally or transdermally by patch offers the possibility of a treatment which can be given for a short therapeutic trial or as a treatment regimen with day-to-day control and flexibility of dose.