Numerous studies have shown that adding testosterone to hormone therapy can improve sexual function and overall well-being in women during menopause. A recent systematic review and meta-analysis of testosterone treatment in women have strongly supported the possibility of conducting a trial with testosterone in women when clinically indicated. In postmenopausal women, testosterone supplementation improved several areas of sexual response, including sexual desire, pleasure, arousal, orgasm, and self-image. An international working group of experts from major medical societies, convened by the International Menopause Society, recently drafted a global position statement to provide clear guidance on prescribing and measuring testosterone for female testosterone therapy, as well as advice on testosterone prescribing practices that may prove ineffective or cause harm. Recognized benefits included improved sexual desire, arousal, orgasm, and pleasure, along with a reduction in worries and distress related to sexual intercourse.
It is recommended to measure testosterone levels at the start of treatment and 3 to 6 weeks after the start of treatment. Patients should be monitored to determine their clinical response to treatment and evaluated for signs of excess androgens, with a serum total testosterone level every 6 months for overuse. It should be discontinued after 6 months if there has been no response to treatment. The bone mineral density of hypogonadal men decreases as testosterone levels decrease, which could increase the risk of fractures. Bioavailable levels of testosterone and estrogen are more correlated with changes in density than total testosterone.
Testosterone replacement can stop bone loss and increase bone density. However, many studies show misleading results and none have demonstrated a decrease in the fracture rate with testosterone therapy. Testosterone treatment consistently increases lean body mass; however, muscle strength does not increase significantly. Hypogonadism hinders the ability to produce normal amounts of testosterone due to a problem in the testicles or the pituitary gland that controls the testicles. Testosterone replacement therapy, in the form of injections, granules, patches, or gels, may improve the signs and symptoms of low testosterone levels in these men.
The male hormone testosterone plays an important role in the development and maintenance of typical male physical characteristics, such as muscle mass and strength, and the growth of facial and body hair. The Food and Drug Administration (FDA) has stated that large scale use of testosterone therapy is not appropriate to prevent possible future illnesses or to improve strength or mood in otherwise healthy older men. An international working group comprised of experts from major medical societies has recently developed a global position statement to provide clear guidance on prescribing and measuring testosterone for female testosterone therapy, as well as advice on testosterone prescribing practices that may prove ineffective or cause harm. It is recommended that doctors monitor women who take testosterone for virilization and that they perform baseline and biannual breast exams, a complete blood cell count, lipid levels, an annual mammogram, and an endometrial ultrasound. Since most menopausal women can receive treatment in primary care, the new guidance on BMS will help family doctors feel confident to start administering testosterone if appropriate or to continue with prescriptions that have been started in specialized clinics. Approximately 98 percent of circulating testosterone binds to globulin or albumin which binds to the steroid hormone. Up to 50 percent of postmenopausal women have sexual dysfunction and a low level of testosterone has been correlated with a lower coital frequency in these women. More studies are needed to determine the exact role of testosterone and TRT in cardiovascular risk.
The American Association of Clinical Endocrinologists (AACE) has published guidelines for testosterone supplementation in men and guidelines for women are being developed. Testosterone replacement is most commonly prescribed to treat problems with libido, sexual enjoyment, and orgasm in patients who are postmenopausal or who have undergone an oophorectomy. Once the diagnosis of LOH is confirmed testosterone replacement therapy (TRT) should be considered with the goal of improving secondary sexual characteristics, sexual function, sense of well-being, and bone mineral density. Having a licensed testosterone preparation available to women would certainly be a step in the right direction. Therefore except for older men total serum testosterone should be initially measured in the morning (7 to 11 a.m.) if a test is necessary.
