We have selected a few abstracts from studies done on the effects of low testosterone, and testosterone supplementation in women. Sometime referred to as “the hidden disease”, low testosterone in women has been overlooked mainly due to testosterone being viewed primarily as a “male hormone”. Women have testosterone too, although in smaller amounts than men, but this small amount is necessary for many important functions highlighted in the studies below. The potential side effects listed within many of these studies as a concern are acne and facial hair growth (hirsutism) but we know that this can be mitigated with proper dosing. If acne or facial hair growth occur, typically this means the testosterone is dosed too high. Proper dosing will not produce these effects.

In summary, some of the benefits of testosterone supplementation in the aging female include;

  • Improved body composition
  • Increase in bone density
  • Increased libido and sexual function
  • Improved well-being, reduced depressive symptoms

STUDY #1

Androgen Replacement in Women: A Commentary

Susan Davis

The Jean Hailes Foundation, Clayton, Victoria 3168, Australia

Address all correspondence and requests for reprints to: Dr. Susan Davis, The Jean Hailes Foundation, 173 Carinish Road, Clayton, Victoria 3168, Australia. E-mail suedavis@netlink.com.au.

Abstract

There is increasing evidence to suggest that many postmenopausal women experience symptoms alleviated by androgen therapy and that such symptoms may be secondary to androgen deficiency. Affected women complain of fatigue, low libido, and diminished well-being, symptoms easily and frequently attributed to psychosocial and environmental factors. When such symptoms occur in the setting of low circulating bioavailable testosterone, testosterone replacement results in significant improvement in symptomatology and, hence, quality of life for the majority of women. Whether the apparent therapeutic effects of testosterone replacement are mediated by testosterone and its metabolite 5 – dihydrotestosterone or are a consequence of aromatization to estrogen is not known. Despite the paucity of data regarding its effects, inclusion of testosterone in postmenopausal hormone replacement regimens is not uncommon and is likely to become more widespread with the availability of preparations developed specifically for women.

Clin Endocrinol Metab. 2006 May;91(5):1683-90. Epub 2006 Feb 14.

STUDY #2

Effects of testosterone replacement in androgen-deficient women with hypopituitarism: a randomized, double-blind, placebo-controlled study.

• Miller KK , • Biller BM, • Beauregard C, • Lipman JG, • Jones J, • Schoenfeld D, • Sherman JC, • Swearingen B, • Loeffler J, • Klibanski A.

Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. kkmiller@partners.org

CONTEXT: Hypopituitarism in women is characterized by profound androgen deficiency due to a loss of adrenal and/or ovarian function. The effects of testosterone replacement in this population have not been reported.

OBJECTIVE: The objective of the study was to determine whether physiologic testosterone replacement improves bone density, body composition, and/or neurobehavioral function in women with severe androgen deficiency secondary to hypopituitarism.

DESIGN: This was a 12-month randomized, placebo-controlled study. SETTING: The study was conducted at a general clinical research center. STUDY PARTICIPANTS: Fifty-one women of reproductive age with androgen deficiency due to hypopituitarism participated. INTERVENTION: Physiologic testosterone administration using a patch that delivers 300 microg daily or placebo was administered.

MAIN OUTCOME MEASURES: Bone density, fat-free mass, and fat mass were measured by dual x-ray absorptiometry. Thigh muscle and abdominal cross-sectional area were measured by computed tomography scan. Mood, sexual function, quality of life, and cognitive function were assessed using self-administered questionnaires.

RESULTS: Mean free testosterone increased into the normal range during testosterone administration. Mean hip (P = 0.023) and radius (P = 0.007), but not posteroanterior spine, bone mineral density increased in the group receiving testosterone, compared with placebo, as did mean fat-free mass (P = 0.040) and thigh muscle area (P = 0.038), but there was no change in fat mass. Mood (P = 0.029) and sexual function (P = 0.044) improved, as did some aspects of quality of life, but not cognitive function. Testosterone at physiologic replacement levels was well tolerated, with few side effects.

CONCLUSIONS: This is the first randomized, double-blind, placebo-controlled study to show a positive effect of testosterone on bone density, body composition, and neurobehavioral function in women with severe androgen deficiency due to hypopituitarism.

PMID: 16478814 [PubMed - indexed for MEDLINE]

STUDY #3

A clinical update on female androgen insufficiency–testosterone testing and treatment in women presenting with low sexual desire.

Sex Health. 2006 May;3(2):73-8.

  • Burger HG,
  • Papalia MA.

The Jean Hailes Foundation, Clayton, Australia. henry.burger@princehenrys.org

The diagnosis of female androgen deficiency syndrome is suggested by complaints of a diminished sense of well being, persistent unexplained fatigue and decreased sexual desire, sexual receptivity and pleasure in a woman who is oestrogen-replete and in whom no other significant contributing factors can be identified. The diagnosis is supported by the finding of low circulating concentrations of free testosterone. Barriers to its recognition include the non-specificity of the symptoms and methodological problems due to insensitive testosterone assays. Barriers to its treatment include the unavailability of satisfactory forms of testosterone for administration to women and lack of data regarding long-term safety. Although several conditions lead to clear-cut androgen deficiency, such as hypopituitarism, adrenal and ovarian insufficiency, glucocorticoid therapy and use of oral contraceptives and oral oestrogens, it is important for clinicians to recognise that in normal women, androgen levels decline by 50% from the early 20s to the mid 40s, and hence age-related androgen insufficiency may occur in women in their late 30s and 40s, as well as postmenopausally. Satisfactory measurements of free testosterone requires a sensitive and reliable assay for total testosterone, and quantitation of sex hormone binding globulin, from which free testosterone is readily calculated. Adverse effects of testosterone treatment are few if replacement is monitored to achieve physiological circulating testosterone concentrations. Currently, available methods include testosterone implants and testosterone creams, and transdermal patches and sprays are in development.

PMID: 16800391 [PubMed - indexed for MEDLINE]

STUDY #4

Correlates of sexual functioning among mid-life women.

Climacteric. 2007 Apr;10(2):132-42.

Gallicchio L, Schilling C, Tomic D, Miller SR, Zacur H, Flaws JA.

Prevention and Research Center, Weinberg Center for Women’s Health & Medicine, Mercy Medical Center. Baltimore. Maryland.

Objective: Studies have reported a decline in sexual functioning among women undergoing the menopausal transition. Few studies, however, have examined the associations between hormones and sexual dysfunction during this time period. Therefore, the purpose of this study was to examine the associations between participant characteristics and endogenous hormones with sexual functioning in mid-life women.

Methods: Data were analyzed from a community-based sample of 441 women aged 45-54 years who stated that they were sexually active at the time of the study. Each participant completed a survey that included questions pertaining to sexual functioning and provided a blood sample that was used to measure estrogen and androgen concentrations.

Results: Among women who reported being sexually active, poorer self-reported health and the experiencing of depressive symptoms were significantly associated with not being satisfied with sexual relations after adjustment for other covariates. None of the hormones examined were significantly associated with overall sexual satisfaction. However, statistically significant associations between both total testosterone levels and the free testosterone index with satisfaction with the frequency of sexual relations were observed.

Conclusions: Our findings indicate that the experiencing of depressive symptoms and the reporting of poor overall health are important correlates of sexual dysfunction. Further, our results suggest that higher total and free testosterone levels are significantly associated with a desire for increased frequency of sexual relations among mid-life women.

PMID: 17453861 [PubMed - in process]

STUDY #5

Androgen supplementation in older women: too much hype, not enough data.

Am Geriatr Soc. 2002 Jun;50(6):1131-40.

Padero MC, Bhasin S, Friedman TC.

Division of Endocrinology, Metabolism, and Molecular Medicine, Charles Drew University of Medicine and Science, 1731 East 120th Street, Los Angeles, CA 90059, USA.

Androgen supplementation in women has received enormous attention in the scientific and lay communities. That it enhances some aspects of cognitive function, sexual function, muscle mass, strength, and sense of well-being is not in question. What is not known is whether physiological testosterone replacement can improve health-related outcome in older women without its virilizing side effects. Although it is assumed that the testosterone dose-response relationship is different in women than in men and that clinically relevant outcomes on the above-mentioned effects can be achieved at lower testosterone doses, these assumptions have not been tested rigorously. Androgen deficiency has no clear-cut definition. Clinical features may include impaired sexual function, low energy, depression, and a total testosterone level of less than 15 ng/dL, the lower end of the normal range. Measurement of free testosterone is ideal, because it provides a better estimate of the biologically relevant fraction. It is not widely used in clinical practice, because some methods of measuring free testosterone assay are hampered by methodological difficulties. In marked contrast to the abrupt decline in estrogen and progesterone production at menopause, serum testosterone is lower in older women than in menstruating women, with the decline becoming apparent a decade before menopause. This article reviews testosterone’s effects on sexual function, cognitive function, muscle mass, body composition, and immune function in postmenopausal women.

PMID: 12110078 [PubMed - indexed for MEDLINE]

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