The use of testosterone in post menopausal women
Testosterone information was contributed by
Dr Keith Spowrt, BSc(Hons), MBChB, FRCOG.
Regardless of on-going controversies surrounding long-term use of estrogen and estrogen-progestogen preparations, there is little doubt that hormone replacement therapy is effective in the management of some of the symptoms that result from ovarian failure. Systemic therapy is advised for vasomotor symptoms such as flushing and sweating, whereas local topical preparations are appropriate for symptoms of vaginal dryness.
The ovary also contributes to the production of the "male" hormone, testosterone, in women; after surgical removal of the ovaries, circulating testosterone levels drop by 50%. Levels may also be reduced in women after a hysterectomy with conservation of the ovaries; this is possibly because the blood supply to conserved ovaries may be adversely affected by surgery. Less commonly other illnesses may be associated with low testosterone level, and women with premature ovarian insufficiency may have low testosterone levels.
For this reason there has been interest in the use of testosterone to treat postmenopausal women. Some studies have indicated improved mood and sense of well being, though evidence for this is limited. Furthermore, the use of testosterone is associated with improvements in some aspects of female sexual function and is an option that some women may wish to consider.
Currently the only recommended indication for use of testosterone for women is for persistent low sexual desire (known as hypoactive sexual desire disorder, HSDD) after all other contributory factors have been addressed. Sexual desire in women is complex and factors such as low energy, anxiety, low mood, vaginal dryness and discomfort, as part of menopausal symptoms, along with relationship issues, life stresses, should all be considered. Testosterone replacement may not be the magic answer!
Previously in the UK, testosterone could be given in implant form or patch. However, the patch has now been withdrawn and the implant is only currently available in some clinics. The implant involves the insertion of a pellet every 6 months under the skin using local anaesthetic. A tablet form of HRT, tibolone, contains a combination of estrogen, progestogen and testosterone and can be taken by women who are postmenopausal. Testosterone gel can be used but is currently only licensed for use in men in the UK and would be used in a smaller dose for women only under specialist advice. At the moment it is usual to offer testosterone therapy only to women who are already using systemic estrogen treatment.
As with all treatments, the possibility of side effects requires to be considered. Skin changes, slight increases in facial hair and deepening of the voice are rare; even less likely are abnormalities of liver function. These adverse effects can be minimised by monitoring the levels of testosterone in the blood.
Women who may wish to consider the use of testosterone therapy should discuss the options with their doctor.