Testosterone is a steroid hormone produced in the ovaries and adrenal glands in women. Although typically associated with being a male hormone, a decline in testosterone levels can affect women as well. Of major concern among health care profefessionals is that most current therapy treatments release levels of the hormone well above those considered to be appropriate for women. While there have been a number of studies examining the effects of testosterone therapy in men, as yet, there are no long-term studies on the safety of testosterone replacement therapy for women.
Hypgonadism is just another name for testosterone deficiency in males or females. While both men and women can suffer from the condition, much more is known about the deficiency as it relates to men. What research does show is that women only produce about 10 percent of the amount of testosterone produced by men. While the ovaries normally secrete sex hormones in women, the purpose of testosterone replacement therapy is to supply the body with a normal level of the hormone when deficiency occurs. Among some of the causes, hypogonadism may be an inherited condition, the result of serious nutritional deficiencies or certain types of tumors.
Women who complain of tiring easily, gaining weight while eating less, and diminished sex drive, may be suffering from decreased levels of testosterone. Not losing weight even while exercising regularly and slowed reaction time are sometimes other symptoms that testosterone levels may be low. Testosterone deficiency in women can cause hair loss, hot flashes and amenorrhea, or the absence of menstruation. If this hormonal deficiency develops before a female reaches adulthood, it can delay puberty, cause irregular periods or prevent pregnancy later in life. A common symptom in female children is short stature.
Causes of Deficiency
While levels of testosterone fall more gradually with age, by the time a woman reaches her 40s, she only has about half the hormone in her bloodstream as a woman in her 20s. Even though the production of testosterone naturally decreases with age, certain diseases or damage to the pituitary gland or hypothalamus can slow down production of the hormone. Radiation and chemotherapy can cause testosterone deficiency as well, in addition to tumors of the pituitary gland or hypothalamus. Infections like meningitis, mumps or syphilis cannot be ruled out as possible causes for the hormone deficiency.
Types of Treatment
Testosterone is offered by prescription in tablet form or lozenge. The steroid can also be administered by intramuscular injection, pellets (which are implanted just below the skin in the front of the lower abdomen), patch, cream or gel. Pellets seem to be the best form of testosterone replacement therapy for women as the hormone is released into the bloodstream slowly. A pellet lasts for between 4 to 6 months, after which time it needs to be replaced. Tablets or injections are not normally recommended for women because they were originally developed for men at much higher doses than those needed by women. Low-dose patches may be a safer treatment option, as much lower doses of the hormone are released into the blood, thereby not affecting the liver. The patch, which can be applied to the stomach, thighs, back or upper arms, slowly releases testosterone into the system over a 24-hour period. Skin irritation and localized skin reactions to the patch have been reported in some people. Testosterone gel, which is easy to use, is usually applied each morning to the inner thighs, stomach or shoulders. There is still some question about the effectiveness of the gel for women. It doesn't matter, though, how hormone therapy is administered, because of the many potential adverse effects, finding the right dose of testosterone replacement can be a challenge, especially for women.
Benefits of testosterone replacement therapy for women may include increased strength and endurance, reduced percentage of body fat, more lean muscle mass, increased sex drive, and improved memory and mood, not to mention an increase in energy. Some studies suggest that higher testosterone levels may also help to protect against heart disease, as well as build muscle and bone mass. Some doctors prescribe testosterone supplements along with hormone replacement therapy for postmenopausal women with low libidos. Women who have their uterus and ovaries removed obviously experience a decline in the production of testosterone. In these cases, too, testosterone replacement therapy may help to alleviate some of the symptoms associated with menopause. However, even though testosterone treatment may prove beneficial to some women, doctors recommend that before starting testosterone replacement therapy, a woman should have a blood test to measure current levels. Women with already high levels of testosterone should not receive therapy. Additional lab work should be ordered to exclude thyroid dysfunction and iron deficiency as causes for their symptoms. The best time to draw blood is between 8 a.m. to 10 a.m. as levels of testosterone in a woman's bloodstream can fluctuate throughout the day. Testosterone levels also tend to be low during a woman’s menstrual cycle, therefore, any lab work should wait until at least 8 days after the start of menstruation in order to get a more accurate reading.
The effects of testosterone replacement therapy in women with hormone deficiency is unclear. Testosterone replacement therapy has been found to change cholesterol levels in the blood, particularly in women who may already have low levels of HDL (good cholesterol). Research also suggests that hormone therapy can increase blood viscosity, affecting blood flow, and worsen breast and prostate cancers. Women have reported side effects including severe acne, fluid rentention and hair loss on the scalp while receiving treatment. Some studies suggest that women taking a combination of estrogen and testosterone replacement therapies are at a significantly increased risk for breast cancer.
Studies have linked testosterone deficiency to muscle weakness and osteoporosis. Testosterone prescribed in pill form is usually in much higher doses than a woman’s body would produce naturally. Such high doses in women have the potential to cause elevated cholesterol, severe acne, and perhaps even liver problems. Women who are pregnant or lactating should not receive testosterone therapy. Doctors who recommend hormone replacement for postmenopausal women or those who have undergone hysterectomies should prescribe the lowest dose possible, as well as check the woman’s cholesterol every 6 months and liver function at least once each year. Women with a previous history of cardiac, kidney or liver problems should not consider hormone therapy.