Testosterone is commonly referred to as a male hormone. However testosterone is also an essential hormone for women. While circulating levels of testosterone are higher in men, the hormone is also prevalent in women throughout their life. It is an important hormone for health and well-being for both men and women although it is not always recognized as such.

Testosterone Misconceptions

One misconception about testosterone in women is that it only plays a role in libido. However testosterone affects many parts of the body – women have androgen receptors in their breasts, heart, blood vessels, gastrointestinal tract, vaginal tissues, and more. Both men and women experience the side effects of declining hormone levels as they age. Physical fatigue, muscle loss, mood changes, and sexual dysfunction can occur for men and women.

Testosterone is often associated with masculinity but when discussing administering it for hormone replacement therapy, it is actually dose dependent. Lower doses in women can actually have “feminizing” effects. There is an increase in endogenous (natural in the woman’s body) production of testosterone in women when they are pregnant. The fetus is protected by the placenta which diffuses hormones. So despite the preconceptions, testosterone is also a “female” hormone.

While a lot of research in the past focused on testosterone’s role in promoting male aggression, more recent research has disputed this simple causal relationship. A more complex understanding shows that testosterone can be associated with both aggression and cooperation depending on context. Testosterone can have different effects in men and women and its exact effects on behavior are not completely understood yet.

Testosterone and Libido in Women

One of the main reasons testosterone is prescribed to post-menopausal women along with estrogen is its effects on sexual desire. Despite the fact that testosterone does more for a woman’s health than act as a “sex” hormone it has been shown to be effective for this indication. Testosterone levels have been shown to affect sexual desire in premenopausal and postmenopausal women. In particular, testosterone therapy has been studied for treating low sexual desire in postmenopausal women.

In a recent meta-analysis that included 36 randomized controlled trials, it was found that testosterone therapy significantly improved sexual functioning for many women. The researchers concluded from their analysis that compared with placebo or a comparator (e.g., estrogen, with or without progesterone), testosterone significantly increased sexual function –  including satisfactory sexual event frequency, sexual desire, pleasure, arousal, orgasm, responsiveness, and self-image – and reduced sexual concerns and distress in postmenopausal women.

The meta-analysis found that the most significant adverse effects reported with testosterone treatment were increases in acne and hair growth. However these side effects were not associated with women dropping out of the studies so it seems that they were not severe enough to warrant discontinuing treatment. No serious adverse effects were found to be associated with testosterone use in women. With oral forms, it was shown that there was a significant rise in the amount of LDL-cholesterol, and reduction in the amounts of total cholesterol, HDL-cholesterol, and triglycerides. These changes did not occur for women using transdermal forms of testosterone.

It should be noted that these beneficial effects were shown in studies on postmenopausal women. Although premenopausal women may also be looking for a treatment that can improve sexual functioning, there is very little data on the effect of testosterone in this group. In addition, the analysis did not find enough evidence to support the prescribing of testosterone for treating depression or mood swings in postmenopausal women. While there is evidence that testosterone can have an impact on depression in men, the research on women is not conclusive.

HSDD

Hypoactive sexual desire disorder/dysfunction (HSDD) is a term used to refer to one type of sexual disorder. It is one of the most common sexual dysfunctions to have and basically refers to a low sex drive. People with HSDD may have little or no desire for sex including a lack of thoughts and fantasies. There are numerous possible causes for HSDD and often multiple factors can contribute. Anxiety and stress, relationship issues, certain medications, hormone levels and more can all be factors. In many cases lifestyle changes can significantly affect this condition without the use of medication. However a few different medications do exist, which includes those specifically made to treat the condition (like bremelanotide and flibanserin) and hormone replacement therapy.

Health Benefits of Testosterone for Women

Besides its well-known effects on libido, testosterone may have a few different health benefits for women although the research is not always as strong as it is for increasing libido. For example, higher free testosterone levels have been associated with lower fracture rates in older women. However this might be due to the conversion of testosterone to estradiol. The research continues on the potential health benefits of administering testosterone as a therapy for postmenopausal symptoms in women.

Compounded Testosterone

A global consensus position statement on the use of testosterone therapy for women established a number of useful recommendations. Regarding the compounding of testosterone, it was determined that dosing should be limited to achieving testosterone concentrations in the physiologic premenopausal range. The dosages of testosterone cream that our pharmacy compounds for women are significantly lower than those we compound for men. We do not compound dosages for women that are supraphysiologic, which means we do not compound dosages of testosterone that would result in levels higher than would occur naturally in a premenopausal woman on average.

Currently, there are no manufactured/FDA approved testosterone products available in dosages that are specifically designed for women. This means that doctors either prescribe a product designed for men off-label, or they use the services of a compounding pharmacy. The dosages that are designed for men are significantly higher than those that should be used for women.

Articles

• Testosterone therapy in women: Myths and misconceptions – Maturitas (link opens in new window)
• Effects of testosterone therapy for women: a systematic review and meta-analysis protocol – Systematic Reviews (link opens in new window)
• Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data – The Lancet Diabetes & Endocrinology (link opens in new window)
• Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen – The New England Journal of Medicine (link opens in new window)
• Global Consensus Position Statement on the Use of Testosterone Therapy for Women – The Journal of Clinical Endocrinology & Metabolism