Is testosterone important for women as they age?

Abstract

In women, is testosterone an obligatory precursor for extra-gonadal estradiol production after menopause, and has important direct androgenic genomic and nongenomic effects. Testosterone levels in women decline with age from the 4th decade, reaching a nadir in the 7th decade of life. Testosterone levels are positively associated with sexual function in women, and multiple randomised placebo-controlled trials have shown that testosterone therapy can be effective for the treatment of female sexual dysfunction in postmenopausal women. However, low testosterone in ageing women has multiple potential undesirable consequences that have been somewhat ignored. In the brain, testosterone exhibits neuroprotection against oxidative stress, serum deprivation-induced apoptosis and soluble amyloid beta toxicity, and clinical trials suggest exogenous testosterone enhances cognitive performance in postmenopausal women. Lower free testosterone in older women is associated with a decline in bone mineral density and a greater risk of hip fracture. Observational studies implicate testosterone as having favourable cardiovascular effects measured by surrogate outcomes, however associations between endogenous testosterone and CVD risk, and total mortality, particularly in older women are yet to be established.