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,0606 the
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 equivalent, 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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