Exogenous androgens in postmenopausal women

Abstract

There is an increasing awareness that androgens are of therapeutic value in postmenopausal women. Evidence is emerging demonstrating the role of testosterone in both female embryologic development and normal sexual behavior and mood. Women who are androgen depleted develop physical and behavioral symptoms referred to as female androgen deficiency syndrome. To a lesser degree, women who undergo an oophorectomy are deprived of endogenous ovarian androgens and have consistently been shown to have impairment of sexual functioning, loss of energy, depression, and headaches. Testosterone seems to act synergistically with estrogen in the treatment of these symptoms. The combination of estradiol and testosterone has been shown to have a beneficial effect on the skeleton, although not significantly better than estradiol therapy alone. Cosmetic side effects are rare if supraphysiologic doses are avoided. The potential metabolic complications have not been consistently demonstrated in studies to date. Androgen replacement therapy is a neglected area of medical practice and further research is needed to identify all women who will benefit from it since studies in menopausal women have shown parenteral administration to be well tolerated and safe. Such therapy is underused and very much underresearched. While testosterone implants work adequately, it would be more desirable and convenient to use a testosterone patch and safer, more effective oral androgens, if these products were available.