Emerging Role of Testosterone in Menopause

Abstract

Testosterone therapy is being increasingly used in the management of postmenopausal women and has now been approved for the treatment of surgically postmenopausal women in European countries. However, neither the US FDA nor my own country, Thailand, have approved the administration of testosterone for any indication for women. The derivation of the word testosterone is from the stems of testicle and sterol and the suffix of ketone [1]. Testosterone was originally used for the treatment of males with low or no natural endogenous testosterone production, socalled male hypogonadism. It was not until 1950 that the importance of testosterone on female sexuality was first mentioned [2–4], but since then research into this aspect has progressed significantly. Many studies have been conducted to establish the symptoms or syndrome caused by low levels of endogenous testosterone. However, the results remain inconclusive. This may be attributable to the complexity of the proposed symptoms of female androgen insufficiency. Nonetheless, the term ‘female androgen insufficiency’ is derived from the effects of pharmacological androgen-replacement regimens [5]. Despite an uncertain association between low testosterone levels and a female androgen insufficiency syndrome, several clinical trials have been conducted and have shown some benefits of adding exogenous testosterone to traditional hormone therapy in postmenopausal women. The proposed benefits of the addition of exogenous testosterone to hormone therapy are the improvements in wellbeing, sexual function, unexplained fatigue, bone health, body composition and cognition. Among these, the only well-documented benefit has been an improvement in sexual function with various regimens of testosterone use. The supporting evidence is level 1 [6]. All randomized, controlled studies