The daily production of testosterone in women is 20-30 times less that of men. Despite the difference in production, testosterone can be just as important in women as in men. The ovaries and the adrenal glands produce half of women’s testosterone; the other half comes from “conversion” of steroid hormones, such as DHEA, to testosterone. Testosterone levels decline with age, usually beginning around age 40 in women.
Actions of Testosterone in Women
- Improvement of mood and assertiveness
- Reduction of depression and anxiety
- Improved bone density
- Improved muscle size and strength
- Enhancement of sex drive and sexual sensitivity
- May protect against atherosclerosis
Common Symptoms of Testosterone Deficiency in Women
Physical:
- Decreased or absent: libido, clitoris sensitivity and/or orgasm
- Vaginal itching
- Painful intercourse
- Reduced muscle strength
- Joint pains
- Dry skin
Mental:
- Depression
- Excessive anxiety and worrying
- Excessive emotions
- Inability to deal with stressful situations
Treatment
The majority of women deficient in testosterone also have other female hormone deficiencies; therefore, testosterone treatment is usually done in conjunction with other hormone replacements.
Requirements for Monitoring Therapy:
- Baseline and periodic blood test including testosterone, DHEA, estrogen and progesterone levels.
Medication:
Testosterone replacement is available in many forms. Small doses are used for women’s replacement and the dose will be adjusted to obtain positive effects while preventing unwanted side effects. Testosterone replacement can work slowly. The first improvements are usually emotional and sexual appearing within the first four months of treatment. Improvements in muscle mass and bone density may take up to eight months.
- Sublingual (under the tongue) tablets
- Trans-dermal (topical cream or patch)
- Injections (possible, but not the best for women)
- Oral testosterone (not recommended)
- Pellet implants (not recommended)
Signs and Symptoms of Too Much Testosterone Replacement
- Facial hair
- Excessive body hair
- Acne
- Oily skin
- Swelling of the feet
- Excessive sex drive
- Excessive aggression or authoritarian attitude
- Excessive muscle development
The unwanted signs of too much testosterone are typically easy to correct and reversed with dose adjustments and concurrent female hormone replacement.
Risks and Benefits of Treatment
Risks:
- May include hair growth on the face or body, hair loss on the scalp, oily skin or acne, hoarseness or deepening of the voice, fluid retention, diminished breast size and increased clitoris size. Women who are pregnant or who could become pregnant should not take testosterone, since it can cause abnormal fetal development.
- Since testosterone treatment longer than six months in duration has not been studied, researchers do not yet know whether testosterone drugs can affect factors like risk of breast cancer, heart disease or blood clots in women.
Contraindications:
- Active or untreated breast or uterine cancer is an absolute contraindication for all testosterone replacement.
- History of treated breast or uterine cancer is a relative contraindication and treatment should occur only with specific education as to the risk and benefits in this particular situation.
Benefits:
- May improve sexual desire, orgasm, mood, drive, ambition, confidence, security
- Improves muscle strength and fitness, bone density
