Why Do Women Need Testosterone Replacement?
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Effect of Testosterone in Women
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Women produce small amounts of the male hormone testosterone throughout their lives. The ovaries produce almost all of the testosterone that circulates in a woman's body, with the adrenal glands producing small amounts of the hormone. In women, testosterone heightens sexual desire (libido) and satisfaction, increases energy, builds and maintains lean muscle mass and strengthens bone.
Testosterone Deficiency in Women
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Testosterone production in women increases at puberty and gradually declines as women age. By age 40, a woman's testosterone levels are approximately half of what they were when she was in her 20s. The drop in testosterone levels is unrelated to the onset of menopause. Although testosterone decline begins before a woman enters menopause, the effects of low testosterone generally go unrecognized until after menopause when estrogen production ceases. Symptoms of low testosterone levels include reduced libido, fatigue or lack of energy and depression. Low libido and reduced sexual satisfaction is called hypoactive sexual desire disorder (HSDD).
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Treatment
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Testosterone replacement therapy may be recommended for women suffering from the effects of low testosterone levels. If reduced sexual desire results from other factors, such as declining estrogen levels, medications side effects or underlying health conditions, testosterone replacement therapy will be ineffective. Only one testosterone replacement, Estratest, is approved by the U.S. Food and Drug Administration for use in women. Although Estratest, which is a combination of estrogen with a small amount of testosterone, is only approved to relieve menopause symptoms, physicians may prescribe it for HSDD. Estrogen replacement therapy alone is ineffective in treating HSDD, but adding testosterone improves sexual desire, increases a sense of well being and helps prevent bone loss, which increases as estrogen levels diminish. A skin patch that delivers continuous low levels of testosterone, called Intrinsa, is available in Europe and Canada but not the U.S. because of questions concerning an increased risk of breast cancer with long-term use.
Side Effects
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The most common side effects associated with testosterone replacement therapy in women include acne and excess facial hair. Women taking testosterone replacements may also experience a deepening voice, liver complications, decreased high-density lipoprotein (the so-called "good" cholesterol) levels and changes in mood and personality. Testosterone replacement therapy should only be used in postmenopausal women taking estrogen replacement therapy. Testosterone therapy should not be used in women who are not taking estrogen replacements, or who have a history of breast or uterine cancer, cardiovascular disease or liver disease. Testosterone replacement therapy for women remains controversial because no studies examining long-term safety and effectiveness have been performed.
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