Testosterone Therapy in Women

January 26, 2019

Testosterone is the most abundant biologically active hormone in the female body, but unfortunately we start to see this important hormone decline in the mid 30s and 40s.  We believe testosterone has the same beneficial effects in women as it has in men:

  • improved bone density

  • improved sexual function

  • increased sexual interest

  • improved well-being and mood

  • decreased amounts of fat tissue

  • increased lean muscle mass

  • decreased risk of metabolic syndrome and diabetes

  • decreased risk of cardiovascular disease.

Testosterone replacement can be used in women who are interested in improved health and wellness, exercise capacity, sexual function, weight management, and protection from breast cancer.

 

Nothing in life is risk free, so please discuss with your doctor the possible adverse effects of testosterone replacement.   The following are reasons an individual should not use testosterone therapy - pregancy, breast-feeding, liver dysfunction or alopecia (ongoing hair loss).  As with any medication, it’s important to take only the prescribed dose.

 

Routes of Delivery

  1. Patch – This is available in Europe, but has not yet been approved in the United States.

  2. Shots – These are once weekly shots that are more appropriate for men.

  3. Pellets – These are sterile tablets that are inserted into the buttock every 3-6 months that release testosterone slowly.  

  4. Cream applied to the upper thighs which mimics the physiologic diurnal release of testosterone that men experience, albeit at a tiny fraction of the strength.

  5. Cream applied to the inner labia.  Delivery through the labia allows for pretty reliable absorption.

 

Causes of Low Testosterone in Women
 

  • Menopause (the decline in testosterone can start 10 years prior to menopause) 

  • childbirth

  • adrenal stress

  • endometriosis

  • depression

  • psychological trauma

  • oral contraceptive pills

  • statin medications

 

Key Points

  1. Estrogen levels need to be optimized in order for testosterone to be effective.

  2. Testosterone is not well studied in women; it is well studied in men.   There are 30 FDA approved testosterone products for men, but none for women.  Unfortunately, there is no long term safety data in women.

  3. The use of testosterone in women is considered “off label.”  https://www.ncbi.nlm.nih.gov/pubmed/25092967

  4. Effective birth control methods must be used while using testosterone

 

Testosterone Research Studies

  1. In a 7 year study of over 600 men, mortality related to cardiovascular disease was reduced in the group treated with testosterone:  http://journals.sagepub.com/doi/abs/10.1177/1074248417691136

  2. A one year study of 790 men reported in 2016 in the prestigious New England Journal of Medicine, researchers found that treatment with testosterone improved mood, sexual function, energy, muscle strength and bone density.  There was decreased cardiovascular risk in the group treated with testosterone:  

      https://www.nejm.org/doi/full/10.1056/nejmoa1506119

  1. https://www.ncbi.nlm.nih.gov/pubmed/24473536 This study did not show an increase in mood in women who were using testosterone compared to women who were not.

  2. https://www.ncbi.nlm.nih.gov/pubmed/27903495 Per this study in BMJ, testosterone risk IN MEN was associated with increase in risk of thromboembolism in the first six months of testosterone use. There were about 10 extra cases of blood clots per 10,000 men per year linked to testosterone. In the general male U.K. population, there are normally about 16 cases per 10,000 people per year.

  3. https://www.ncbi.nlm.nih.gov/pubmed/26205547   This study showed NO increased risk of clotting in 30,000 MEN

 

 

From the FDA:

“Why might an approved drug be used for an unapproved use?

From the FDA perspective, once the FDA approves a drug, healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient. 
You may be asking yourself why your healthcare provider would want to prescribe a drug to treat a disease or medical condition that the drug is not approved for.  One reason is that there might not be an approved drug to treat your disease or medical condition.  Another is that you may have tried all approved treatments without seeing any benefits.  In situations like these, you and your healthcare provider may talk about using an approved drug for an unapproved use to treat your disease or medical condition.” (https://www.fda.gov/forpatients/other/offlabel/default.htm)

 

More

 

References:

https://www.ncbi.nlm.nih.gov/pubmed/30504369

https://www.ncbi.nlm.nih.gov/pubmed/26160683

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