Testosterone Therapy In Women Research Articles

Testosterone therapy in women: its role in the management of hypoactive sexual desire disorder

Disorders of sexual dysfunction occur in nearly half of women during their life, and hypoactive sexual desire disorder accounts for most of those complaints. Although the relationship between low endogenous testosterone levels and sexual desire disorders in women has not been empirically established, clinical trials have shown that exogenous testosterone therapy improves arousability, sexual desire and fantasy, frequency of sexual activity and orgasm, and satisfaction and pleasure from the sexual act. Its therapeutic role in bone mineral density, fatigue, well-being and hot flashes requires more study before specific recommendations can be made. Potential adverse effects of testosterone therapy include hirsutism, acne and deepening of the voice along with changes in lipid profiles. While less well understood, concern after increased risks for breast cancer and cardiovascular events has been raised about this therapy. Testosterone therapy is available in various formulations; the most commonly used are oral and transdermal, including patches, gels, creams and ointments.

Androgen treatment in women

Purpose of review Testosterone therapy for women, particularly those with natural or surgically induced menopause, albeit controversial, is becoming more widespread. This review presents current data regarding the effects of endogenous androgen and examines recent findings using testosterone therapy in women. Recent findings Current evidence indicates that androgens have important biological effects in women, acting directly via androgen receptors in tissues, such as bone, skin fibroblasts, hair follicles and sebaceous glands. They also act indirectly via the aromatization of testosterone to estrogen on various sites, such as the ovaries, bone, brain, heart and adipose tissue. Data from randomized controlled trials suggest that exogenous testosterone therapy improves sexual function, mood, and bone mineral density in women with androgen insufficiency. Summary Androgen therapy may be necessary for the management of carefully selected women with androgen insufficiency. Women with natural or surgically induced menopause may be candidates for testosterone therapy if they have decreased sexual desire and no other identifiable cause for decreased libido. Data from studies investigating the effects of testosterone therapy in young women with androgen insufficiency are needed. Common adverse effects of testosterone therapy include hirsutism and acne, which reverse with discontinuation of treatment. Long-term trials evaluating safety and effectiveness of testosterone therapy in women are lacking.

The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society

To create an evidence-based position statement regarding the role of exogenous testosterone in postmenopausal women. The North American Menopause Society (NAMS) enlisted a panel of clinicians and researchers acknowledged to be experts in the field of testosterone therapy to review the evidence obtained from the medical literature, compile supporting statements and conclusions, and reach consensus on recommendations. The document was reviewed and approved by the NAMS Board of Trustees. Endogenous testosterone levels have not been clearly linked to sexual function in postmenopausal women. Published evidence from randomized controlled trials, although limited, indicates that exogenous testosterone, both oral and nonoral formulations, has a positive effect on sexual function, primarily desire, arousal, and orgasmic response, in women after spontaneous or surgically induced menopause. Data are inadequate to support recommending testosterone use for any other indication, including preserving or increasing bone mineral density, reducing hot flashes, increasing lean body mass, or improving well-being. Hirsutism and acne have been associated with testosterone therapy, but the actual risks are not well defined. It is not known whether testosterone therapy increases the risk of breast cancer, cardiovascular disease, or thromboembolic events. There are few data regarding the safety and efficacy of testosterone therapy in women not using concomitant estrogen therapy or for the use of testosterone therapy for longer than 6 months. Clinically available laboratory assays do not accurately detect testosterone concentrations at the values typically found in women, and no testosterone level has been clearly linked to a clinical syndrome of hypoandrogenism or testosterone insufficiency. Postmenopausal women with decreased sexual desire associated with personal distress and with no other identifiable cause may be candidates for testosterone therapy. Testosterone treatment without concomitant estrogen therapy cannot be recommended because of a lack of evidence. When evaluating a woman for testosterone therapy, recommendations are to rule out causes not related to testosterone levels (eg, physical and psychosocial factors, medications) and to ensure that there is a physiologic cause for reduced testosterone levels (eg, bilateral oophorectomy). Laboratory testing of testosterone levels should be used only to monitor for supraphysiologic levels before and during therapy, not to diagnose testosterone insufficiency. Monitoring should also include subjective assessments of sexual response, desire, and satisfaction as well as evaluation for potential adverse effects. Transdermal patches and topical gels or creams are preferred over oral products because of first-pass hepatic effects documented with oral formulations. Custom-compounded products should be used with caution because the dosing may be more inconsistent than it is with government-approved products. Testosterone products formulated specifically for men have a risk of excessive dosing, although some clinicians use lower doses of these products in women. Testosterone therapy is contraindicated in women with breast or uterine cancer or in those with cardiovascular or liver disease. It should be administered at the lowest dose for the shortest time that meets treatment goals. Counseling regarding the potential risks and benefits should be provided before initiating therapy.

Testosterone therapy in women: a review

Female sexual dysfunction is a complex problem with multiple overlapping etiologies. Androgens play an important role in healthy female sexual function, especially in stimulating sexual interest and in maintaining desire. There are a multitude of reasons why women can have low androgen levels with the most common reasons being age, oophorectomy and the use of oral estrogens. Symptoms of androgen insufficiency include absent or greatly diminished sexual motivation and/or desire, that is, libido, persistent unexplainable fatigue or lack of energy, and a lack of sense of well being. Although there is no androgen preparation that has been specifically approved by the FDA for the treatment of Women's Sexual Interest/Desire Disorder or for the treatment of androgen insufficiency in women, androgen therapy has been used off-label to treat low libido and sexual dysfunction in women for over 40 y. Most clinical trials in postmenopausal women with loss of libido have demonstrated that the addition of testosterone to estrogen significantly improved multiple facets of sexual functioning including libido and sexual desire, arousal, frequency and satisfaction. In controlled clinical trials of up to 2 y duration of testosterone therapy, women receiving androgen therapy tolerated androgen administration well and demonstrated no serious side effects. The results of these trials suggest that testosterone therapy in the low-dose regimens is efficacious for the treatment of Women's Sexual Interest and Desire Disorder in postmenopausal women who are adequately estrogenized. Based on the evidence of current studies, it is reasonable to consider testosterone therapy for a symptomatic androgen-deficient woman with Women's Sexual Interest and Desire Disorder.

Therapeutic effects of methyl androstenediol

Forty-eight women having endocrine disturbances in which androgen therapy is useful were treated with methyl androstenediol. The therapy was either intramuscular injections of from 25 to 50 mg. of an aqueous microcrystalline suspension, or oral or buccal therapy with tablets of the steroid in daily doses of 25 to 75 mg.Twenty-five women having well-established menopausal symptoms were treated, and twelve had complete relief of symptoms; ten reported marked improvement; three had no relief and these women preferred the effects of estrogens.Nine women having dysmenorrhea were treated; in five, the treatment was started at the preovulatory period, and in four, at the onset of menstrual molimina. This treatment was successful in all of these patients, but it was strikingly successful and convenient in the patients treated in the preovulatory period, for these patients were successfully treated with oral tablets; those in the other group were given injections. In the preovulatory treatment, a total dosage of 350 mg. during a period of seven days appeared to be required, for a dose of 175 mg. gave no relief in two instances.Eight women were treated to suppress lactation, and the results were excellent in seven; in an eighth case congestion developed and the steroid treatment was adjudged a failure. This patient had been nursing her baby for a month prior to starting the treatment.Seven women having mastopathy were treated, and two of these patients also had premenstrual tension. The results were excellent in six. One women experienced no relief of symptoms after a single dose of 25 mg., nor after 100 mg. in a single dose, and this last injection was painful.These experiences with methyl androstenediol lead to the conclusion that this steroid warrants wider investigation, and offers considerable promise as a substitute for testosterone therapy in women.