Testosterone tales for women

Traditionally associated with male health, the role of testosterone in enhancing women's well-being is garnering newfound attention. This exploration delves into testosterone therapy for women from a professional standpoint, aiming to dispel myths and shed light on potential benefits.

Key Considerations for Women:

Libido and Hormonal Balance: Testosterone's impact on sexual desire extends beyond gender lines. Hormonal imbalances can be judiciously addressed with testosterone therapy, mitigating concerns without undesirable side effects provided low testosterone is the culprit.

Energy and Vitality: Beyond its influence on sexual health, testosterone contributes to overall energy levels. While testosterone treatment may assist women with energy-related challenges due to hormonal imbalances associated with ovarian loss or ageing, it cannot replace lifestyle adjustments or address other causes of fatigue.

Bone Health: Maintaining optimal bone density is crucial for women's health, and testosterone, in combination with adequate estrogen, plays a vital role in achieving this.

Concerns Regarding Testosterone Replacement in Women:

Registration: Notably, no testosterone product is currently specifically registered for use in women. Therefore, careful consideration and consultation are essential before commencing testosterone therapy.

Masculinization: Addressing concerns about the development of masculine traits, deepening of the voice, acne, balding, etc, underscores the necessity for professional guidance during testosterone therapy.

Cardiovascular Considerations: Apprehensions about cardiovascular risks in women undergoing testosterone therapy are valid, particularly for those with low estrogen levels. The method of administration, whether oral or depot, can impact associated risks, including hepatic first-pass metabolism.

First-Pass Metabolism and Dosage Implications: First-pass metabolism, a crucial aspect of drug metabolism in the liver, is particularly relevant to testosterone therapy. Higher oral doses may be necessary for therapeutic effects due to extensive first-pass metabolism, heightening associated risks.

Liver Concentrations and Cardiovascular Risk: Elevated concentrations of testosterone and its metabolites in the liver may be linked to cardiovascular risks. Studies suggest that heightened androgen concentrations in the liver can influence lipid metabolism and clotting factors, potentially contributing to cardiovascular concerns.

Testosterone Therapy in Premature Ovarian Insufficiency (POI) vs. Menopause:

Testosterone therapy, while sharing commonalities, presents nuanced considerations when comparing women with premature ovarian insufficiency (POI) to those experiencing menopause. In cases of POI, where ovarian function declines earlier than expected, the therapeutic approach involves addressing the hormonal deficit promptly. Testosterone replacement becomes a crucial component in managing not only the symptoms associated with low testosterone levels but also potential consequences such as decreased bone density and reduced libido in this context.

Contrastingly, in menopause, where hormonal changes occur more gradually, the initiation of testosterone therapy may follow a different timeline. Additionally, the age at which these conditions manifest may influence the overall approach, with considerations for potential long-term implications. In both scenarios, tailored treatments, careful monitoring, and regular assessments by healthcare professionals are imperative to optimise hormonal balance and overall well-being.

Guidance on Testosterone Therapy:

According to the British Menopause Society, following the NICE NG23 recommendations, testosterone is suggested for low libido only after exhausting other options.

Monitoring and Dosing: Continuous monitoring, including baseline and 3-6 week follow-up of free testosterone levels, is crucial. Testosterone in women already on Hormone Replacement Therapy (HRT) should first ensure adequate estrogen and subsequently ensure the dose aligns with the physiological range for females.

Potential Risks and Side Effects: Using higher doses in women could lead to irreversible side effects, including clitoromegaly, deepening of the voice, and male pattern baldness. Hence, regular reviews and discontinuation if there is no improvement are recommended.

Annual Review for Continuing Treatment: For women experiencing positive effects, an annual review, including a free testosterone level, is advised. This comprehensive approach aims to ensure testosterone therapy's ongoing safety and effectiveness.

Conclusion

It is crucial to prioritize consultations with healthcare professionals who possess a deep understanding of hormonal dynamics, conduct meticulous risk-benefit analyses, strictly adhere to evidence-based guidelines, and give utmost priority to safety while providing personalized hormone therapy.