Endocrine Abstracts

‘Androgen replacement therapy’ is a term loosely used in the medical and lay literature, however in the context of this discussion it will be limited to the use of testosterone as a pharmacotherapy. Furthermore, whether the term ‘hypogonadal’ includes naturally menopausal women can also be considered contentious, as the postmenopausal ovary is an ongoing source of sex steroids and thus in the strictest terms such women are not necessarily hypogonadal. Indeed, the point at which a woman becomes ‘hypogonadal’ in terms of testosterone production is not clear, as the levels of the pre-androgens, DHEA, DHEAS and androstenedione decline with age, as does testosterone¹, the bioavailability of testosterone is strongly governed by the circulating level of sex hormone binding globulin and not all women with low levels of the pre-androgens or free testosterone will be symptomatic². Furthermore the production of androgens is not limited to the ovary with the adrenals being a major source of androgens throughout life.

The main clinical benefit of testosterone therapy has been seen for the management of hypoactive sexual desire disorder (HSDD) in both premenopausal and postmenopausal women, with and without concurrent oestrogen therapy^3,4. Other potential benefits include favourable effects on mood and wellbeing, bone density with recent data also suggesting favourable effects on cognitive performance. It is hence the responsibility to ascertain whether their female patients have symptoms that may be alleviated with testosterone therapy and offering the women the options of further assessment and possibly management with testosterone therapy.

1. Davison SL, Bell R, Donath S, Montalto JG & Davis SR. Androgen levels in adult females: changes with age, menopause, and oophorectomy. Journal of Clinical Endocrinology and Metabolism 2005 90 3847–3853.

2. Davis SR, Davison SL, Donath S & Bell RJ. Circulating androgen levels and self-reported sexual function in women. Journal of the American Medical Association 2005 294 91–96.

3. Davis SR, Papalia MA, Norman RJ et al. Safety and efficacy of a testosterone metered-dose transdermal spray for treatment of decreased sexual satisfaction in premenopausal women: a placebo-controlled randomized, dose-ranging study. Annals of Internal Medicine 2008 148 569–577.

4. Davis SR, Moreau M, Kroll R et al. Testosterone for low libido in menopausal women not taking estrogen therapy. New England Journal of Medicine 2008 359 2005–2017.