What is Testosterone?

Testosterone is a steroid hormone from the androgen group. Testosterone is mainly secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands. It is the principal male sex hormone and an anabolic steroid.

The Steroid Pathway To Testosterone (The Male Hormone) and Oestradiol (A Female Hormone)

In both men and women, testosterone plays a major role in health and well-being as well as in sexual function. Testosterone increases libido and energy. An adult human male produces about forty times more testosterone than an adult female, but females seem to be more sensitive. However the overall ranges of testosterone level for males and females are very wide, so that they overlap at the low and high end respectively.

Testosterone is being promoted by many as a treatment for fatigue and sex life, for women as well as men.

 

Testosterone Implants

Testosterone implants have a role for some women with reduced libido or insufficient energy when oestrogen replacement does not suffice. In one study,8701 five aspects of sexual behaviour were monitored in three groups of women four years after hysterectomy and bilateral salpingo-oophorectomy (removal of both ovaries and the Fallopian tubes) for benign disease. One group received oestrogen replacement only, those in the second group were given a combination of oestrogen and testosterone and the third had no hormone replacement. The rates of coitus (sexual intercourse) and orgasm were highest in the group receiving the oestrogen and testosterone. There was a relationship between the blood levels of testosterone and Frequency of intercourse.

In 1985, various parameters of sexual functioning were assessed in a study of 53 surgically menopausal women (the ovaries had been removed).8501 Patients randomly received either an estrogen-androgen combined preparation, an estrogen-alone drug, an androgen-alone drug, or a placebo. Also included were a group of women who had undergone hysterectomy and whose ovaries had been left intact. It was clear that exogenous androgen enhanced the intensity of sexual desire and arousal and the Frequency of sexual fantasies in hysterectomized and oophorectomized women. However, there was no evidence that testosterone affected physiologic response or interpersonal aspects of sexual behaviour. These findings suggested that the major impact of androgen in women is on sexual motivation and not on sexual activity per se.

Androgens may be critical for the maintenance of optimal levels of sexual functioning in postmenopausal women.8701

Women who are androgen depleted develop physical and behavioural symptoms referred to as female androgen deficiency syndrome.9501 To a lesser degree, women who undergo an oophorectomy (ovaries have been  removed) 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. Androgen replacement therapy by parenteral (non-oral) administration to be well tolerated and safe. Such therapy is underused and very much under-researched.

Potential side effects of chronic daily testosterone raise questions about this treatment approach. Chudakov and co-workers0701 hypothesized that a single dose of transdermal testosterone given 4-8 hours prior to planned intercourse in women with hypoactive sexual desire disorder (HSDD) might increase desire without side effects associated with chronic use. Premenstrual women with HSDD received eight packets of gel or identical placebo for use before intercourse twice weekly for 1 month. For a second month, the alternate treatment was given. Ten patients completed the study. On the five-item self-report Arizona, the item "How easily are you aroused?" was significantly improved on testosterone gel vs. placebo. Further research is required to define dosage and time schedule to optimize this effect and determine its clinical relevance.

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.0605 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. It is important 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 quantification 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.

Testosterone therapy improves well-being,0302 mood, and sexual function in premenopausal women with low libido and low testosterone. As a substantial number of women experience diminished sexual interest and well-being during their late reproductive years, further research is warranted to evaluate the benefits and safety of longer-term intervention.

Testosterone Patch

Many surgically menopausal (hysterectomy and removal of the ovaries) women in Europe experience low sexual desire; of these women, 1 in every 3 is concerned about it (this condition is medically known as Hypoactive Sexual Desire Disorder, or HSDD). The frustration caused by low sexual desire may make you feel isolated from your partner and anxious about the health of your relationship.

Although many women experience low sexual desire, it may not be just a passing phase and should not need to be considered to be just a part of getting older.

In an Australian study,0606the efficacy and safety of a testosterone patch in surgically menopausal women receiving concurrent transdermal estrogen was evaluated. Women who were using transdermal oestrogen, were recruited to a 24-week, randomized, double-blind, placebo-controlled trial in Europe and Australia. Forty patients were randomly allocated to placebo or testosterone 300 microg/day (n = 37) treatment. Sixty-one women (79%) completed the trial. All subjects who received at least one application of study medication were included in analysis. The testosterone-treated group experienced a significantly greater change from baseline in the domain sexual desire score compared with placebo. The domain scores for arousal, orgasm, decreased sexual concerns, responsiveness, and self-image as well as decreased distress were also significantly greater with testosterone therapy than placebo.

Others0503, 0505,0508,0509,0607 have also reported that the testosterone patch increased the Frequency of satisfying sexual activity and sexual desire, decreased personal distress, and was well tolerated in menopausal women with hypoactive sexual desire disorder.

A study by Canadian psychologists,0507 examined the effects of testosterone on hypoactive sexual desire in pre- and postmenopausal women compared with an age-matched reference group. Treated participants received 100 mg of testosterone cypionate in oil injected intramuscularly monthly for 3 months. They measured salivary testosterone and scores on the Sexual Desire Inventory pre-treatment and post-treatment. Treated and reference participants' baseline testosterone was e quivalent, however, treated participants exhibited higher testosterone levels than did reference participants post-treatment. As expected, treated participants exhibited lower baseline sexual desire than did reference participants and showed a significant increase in sexual desire post-treatment. This research suggests that testosterone may effectively alleviate hypoactive sexual desire, even in women with normal testosterone levels.

The exact role of androgen replacement therapy for female sexual dysfunction needs further elucidation. In one study, a single dose of vaginally applied testosterone propionate elevated serum levels of testosterone and free testosterone within 6 hours. Nevertheless, this acute rise in androgens had no effects on the female sexual response.0608

At present, no testosterone preparation has been approved by the FDA for the treatment of low sexual desire, so all such therapy is considered to be off-label use at this time. Clear guidelines regarding the diagnosis of androgen insufficiency, optimal therapeutic doses, and long-term safety remain lacking.

A daily 90-microL dose of transdermal testosterone improves self-reported sexual satisfaction for premenopausal women with reduced libido and low serum-free testosterone levels by a mean of 0.8 SSE per month.0801

It is essential that women should be fully advised before a trial of testosterone treatment.

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Women's Health

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    • This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

    I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

     





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