The use of testosterone supplementation in postmenopausal women remains a confusing, sometimes controversial subject. In this article we will outline research that suggest benefits women may see while under testosterone supplementation.
Testosterone is an essential hormone for women. Why is it ignored?
A recent study in the prestigious medical journal The lancet. Diabetes & endocrinology (1) noted that: “Testosterone is an essential hormone for women. Despite the crucial role of testosterone and the high circulating concentrations of this hormone relative to estradiol in women, studies of its action and the effects of testosterone deficiency and replacement in women are scarce.”
That study was in 2015, a shift in the medical community in exploring testosterone supplementation for women seems to be occurring as judged by this May 2020 study in the journal Current Opinion in Urology.(2)
“The past decade has produced a significant number of studies on female sexual dysfunction with a greater understanding of hypoactive sexual desire disorder / female sexual interest/arousal disorder (FSIAD) and treatments in women. The recently published meta-analysis on the safety and efficacy of testosterone for women and the Global Consensus Position Statement on the Use of Testosterone Therapy for Women in 2019 have been pivotal at clarifying safety, efficacy, and guidelines for testosterone therapy. There is a clear need for more research and long-term safety data on the effects of testosterone therapy on cardiovascular health, breast health, cognitive function, and the musculoskeletal system in women with the ultimate goal of an FDA-approved testosterone product for women. Until then, off-label or compounded testosterone therapy will likely remain a popular and prescribed option.”
The medical climate is changing, but testosterone for women is still on the “cusp,” of undersatnding.
The primary indication for the prescription of testosterone for women is loss of sexual desire
While testosterone supplementation in women can provide cardiovascular health, breast health, cognitive function, and the musculoskeletal system in women as noted in the study above. The primary indication for the prescription of testosterone for women is loss of sexual desire, which, of course, causes affected women substantial concern. This was reported in In a February 2020 study from Norwegian obstetricians and gynecologists.(3)
“About 40% of postmenopausal women have decreased sexual desire, causing distress. Estrogen therapy attenuates vaginal complaints but has no effect on sexual desire. Although sexual function has been linked to testosterone, there is no clear relation between sexual desire and circulating levels of testosterone. Nevertheless, treatment with transdermal (patch) testosterone improved sexual function in several randomized controlled trials. Women with hypoactive sexual desire disorder who were treated with testosterone reported more satisfying sexual episodes and sexual desire compared with the placebo group. Adverse effects were mild.”
This is certainly not a new idea. Exploring sexual dysfunction after Hysterectomy and oophorectomy and the seemingly less than hoped for results of synthetic estrogen therapy was discussed in a 2000 paper.(4)
“Although they were receiving standard estrogen-replacement therapy, the base-line sexual function of the women was markedly impaired in comparison with that of normal women of similar age . . . In women who have undergone oophorectomy and hysterectomy, transdermal testosterone improves sexual function and psychological well-being.”
In recent study, in the medical journal Menopause, (5) researchers noted:
Hysterectomy and oophorectomy (the removal of ovaries) are performed to treat various diseases in women, including cancer. These procedures are accompanied not only by a decline in estrogen but also testosterone levels in the blood. Many women who have undergone surgical removal of their uterus and/or ovaries can develop symptoms of sexual dysfunction, fatigue, low mood and decreased muscle mass.
However, “Testosterone administration in hysterectomized women with or without oophorectomy for 24 weeks was associated with dose and concentration-dependent gains in several domains of sexual function, lean body mass, chest-press power, and loaded stair-climb power. Long-term trials are needed to weigh improvements in these outcomes against potential long-term adverse effects.”
Should women use testosterone supplementation to ward off cardiovascular risk?
Above we briefly discussed, through research, that testosterone supplementation may be beneficial for women in helping reduce cardiovascular risks. This too however is subject to controversy. Here again is research developing overtime.
A 2013 opinion published in the journal Current opinion in pharmacology (6) suggests that women with oophorectomy are at greater risk for coronary heart disease than intact women, pointing to a greater risk from testosterone deficiency than from estradiol levels.
In 2019, in the journal Clinical interventions in aging,(7) researchers noted “Testosterone may play a role in the correlation between hypertension and target organ damage in hypertensive postmenopausal women.”
Testosterone for postmenopausal women, “what is a normal reading?”
In 2018 in The Journal of clinical endocrinology and metabolism, (8) researchers noted a controversy in helping women: “Reproductive hormones are important to the pathophysiology of cardiovascular disease in women. However, standard estradiol and testosterone assays lack sensitivity at the levels of postmenopausal women.” There is no standardization of blood levels. This is a problem we have seen in our over 30 years of clinical service to post menopausal women, “why do women with normal readings, feel so bad?” The problem was, is, and remains for many, “what is a normal reading?”
At the Magaziner Center for Wellness, we use bio-identical hormones (BHRT). Before formulating a treatment plan, the doctors at the Magaziner Center for Wellness analyze each patient individually. We use a self-scoring system each time a patient comes in so that we can further customize and assess the success of her treatment as it progresses. This allows us to tweak the dosages so that we can optimize the patient’s results.
We have successfully treated thousands of menopausal and perimenopausal women.
1 Davis SR, Wahlin-Jacobsen S. Testosterone in women-the clinical significance. Lancet Diabetes Endocrinol. 2015 Sep 7. pii: S2213-8587(15)00284-3. doi: 10.1016/S2213-8587(15)00284-3.
2 Ingram CF, Payne KS, Messore M, Scovell JM. Testosterone therapy and other treatment modalities for female sexual dysfunction. Current Opinion in Urology. 2020 May 1;30(3):309-16.
3 Johansen N, Lindén Hirschberg A, Moen MH. The role of testosterone in menopausal hormone treatment. What is the evidence?. Acta Obstetricia et Gynecologica Scandinavica. 2020 Feb 6.
4 Shifren JL, Braunstein GD, Simon JA, Casson PR, Buster JE, Redmond GP, Burki RE, Ginsburg ES, Rosen RC, Leiblum SR, Caramelli KE. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. New England Journal of Medicine. 2000 Sep 7;343(10):682-8.
5 Huang G, Basaria S, Travison TG, Ho MH, Davda M, Mazer NA, Miciek R, Knapp PE, Zhang A, Collins L, Ursino M, Appleman E, Dzekov C, Stroh H, Ouellette M, Rundell T, Baby M, Bhatia NN, Khorram O, Friedman T, Storer TW, Bhasin S. Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial. Menopause. 2013 Nov 25. [Epub ahead of print]
6. Barrett-Connor E. Menopause, atherosclerosis, and coronary artery disease. Curr Opin Pharmacol. 2013 Jan 23. pii: S1471-4892(13)00009-X. doi: 10.1016/j.coph.2013.01.005. [
7 Li N, Ma R, Wang S, Zhao Y, Wang P, Yang Z, Jin L, Zhang P, Ding H, Bai F, Yu J. The potential role of testosterone in hypertension and target organ damage in hypertensive postmenopausal women. Clinical interventions in aging. 2019;14:743.