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Consensus # 8 Testosterone Therapy of Testosterone Deficiency in Women

December 05, 2006

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After a literature review and discussions with physicians from all over the world who are well-versed in treating patients with endocrine disorders, we, the members of the Consensus Group of Experts of the International Hormone Society, think the time is ripe to consider treating testosterone deficiency in aging women.

Studies: Since the 1940’s reports have been published on testosterone treatment of women. In early smaller, often anecdotal case studies, testosterone had been reported to exert progesterone-like activity on the endometrium (reduction of menorrhagia), fluid retention (decreased swelling, including of breast tenderness) and on the nervous system (stimulation of the parasympathic system, calming down the sympathic system that can be excessively activated by estrogens). Beneficial actions in a wide variety of conditions such as loss of libido and sexual sensitivity, vulvar sclerosis, enuresis, sarcopenia and breast cancer (testosterone was shown to counter the development of malignant breast tumors) have been published. Testosterone was even used as a last chance treatment of severe depression in postmenopausal women. In the earliest reports excessive doses were a little too often administered allowing some virilizing side effects to be reported. Nowadays, better structured and larger observational studies and more credible double blind placebo studies have confirmed the positive effects of low doses of testosterone therapy in women, in particular on the mood, quality of life, sexuality, bone density, muscle mass. In several studies higher levels of testosterone and related androgens have been associated with lower degrees of atherosclerosis. One Australian study showed that postmenopausal women had no significant increase in risk of breast cancer if they took testosterone treatment in addition to therapy with female hormones similar to those used in the Women’s Health Initiative study (the well-known double –blind placebo-controlled study where (female) hormone replacement therapy was shown to increase the risk of breast cancer). Thus, well-balanced testosterone therapy may have many beneficial effects on women.

Age-related decline: The serum levels of testosterone generally decrease with age in women. In one study the mean level of testosterone in women of an average age of 40 years was more less than half of that of women of an average age of 21 years. The decline of the serum level of testosterone occurs in women at a faster speed than in men, because most of a woman’s testosterone is derived from DHEA (dehydroepiandrosterone), the major adrenal androgen, which’s level quickly decline after age 30. Consequently, the chances that a women suffers from a testosterone deficiency that requires treatment, quickly increases with advancing age.

Current state of evidence: For the International Hormone Society, the current state of evidence is sufficient to recommend testosterone treatment of testosterone deficiency in women.

IHS recommendation for Diagnosis of Testosterone Deficiency in women:

Interpretation of laboratory tests: When does a woman have a testosterone deficiency? For the consensus group of the International Hormone Society, a testosterone deficiency occurs when women experience signs and symptoms of testosterone deficiency, and have lower levels of testosterone and one or more of its metabolites. What are low levels? Low testosterone levels are borderline low (low, but still inside the reference range) or overtly low levels of testosterone (values beneath the lower reference values of the laboratory) in female patients who clinically suffer from an androgen deficiency syndrome with signs and symptoms of testosterone deficiency. What are the best androgen reference ranges for women? For the International Hormone Society, as most elderly persons have more or less the same body size, weight and volume as when they were young, the best reference range is that of young adults, 18 to 30 years, ages where a woman’s body fully develops and adapts to “optimal” levels of hormones.

Diagnose of testosterone deficiency: The IHS recommends physicians to make an adequate clinical evaluation and collect the symptoms and signs suggestive of testosterone deficiency (such as complaints of loss of sexual appetite, anorgasm, fatigue, depression, sarcopenia, abdominal obesity, osteoporosis, etc.) to diagnose mild to severer degrees of testosterone deficiency in women. The diagnosis is then confirmed by laboratory tests. We recommend to test the female patient for total (and free) testosterone, SHBG (sex hormone binding globulin, the major plasma transporting protein of testosterone and dihhydrotestosterone), dihydrotestosterone or preferably androstanediol glucuronide (its major metabolite), LH (luteinizing hormone), and also, as high levels of estrogens may block androgen activity, serum estradiol, and possibly estrone. Checking the levels of DHEA sulfate, the main provider of testosterone, is also valuable. 24-hour urine analyses of testosterone or its two 17-ketosteroids, androsterone and etiocholanolone (by gas chromatography), may provide additional information.

IHS recommendation for Treatment of Testosterone Deficiency in women: Because of the discomfort and adverse health consequences of testosterone deficiency, we recommend physicians to treat with testosterone or one of its close derivatives any persistent testosterone deficiency in adult female patients, even moderate degrees, if no contra-indication is found. Basically, all women who live long enough may expect to be in need of testosterone supplementation. .

Only small physiological doses of testosterone or of another suitable androgen should be administered, doses that bring the testosterone levels back into the reference range of 21-30 or perhaps 31-40-year olds. In general, the doses of testosterone that are given to women are approximately 20 to 30 times lower than what is given to testosterone-deficient men as the levels and production of testosterone are 20 to 30 times higher. The best routes of administration of testosterone in women are the transdermal route (by means of a gel) and more rarely intramuscular (by injection) route. Some oral preparations ma be justified in certain cases, but physicians should know that oral micronized testosterone e.g. is greatly broken down by the liver after intestinal absorption and works only at very high doses.

IMPORTANT CAUTION:

In almost all cases, testosterone should solely be given to women who simultaneously receive estrogen and progesterone treatment in adequate doses, otherwise virilization signs may occur, even at physiological doses.

Contra-indications:
  • Severe hirsutism
  • Absence of estrogen-progesterone treatment
  • Pregnancy
Conclusion: We have found no convincing evidence against the use of physiological doses of testosterone in adult women presenting borderline or overtly low androgen levels, and in particular low testosterone levels. On the contrary, sufficient significant beneficial effects have been reported to recommend the use of physiological doses of testosterone or one of its close derivatives to correct well–diagnosed testosterone deficiency in women in a program with regular follow-ups. Testosterone treatment should be reserved to women who take at the same time a well-balanced estrogen and progesterone therapy in order to avoid virilism.

References

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9 signatures for this petition
 
1 to 9
 

02/03/2015
Zalud Toni
Austria
(no comment)
10/13/2008
Alenka Radelj
Slovenia
(no comment)
05/07/2008
Erika Gray
United States
(no comment)
05/07/2008
Brian Gray
United States
(no comment)
05/07/2008
Patt Nicol
United States
(no comment)
05/05/2008
Shirley Roberts
United States
I currently am taking a natural hypothyroid medication and it is really much more effective than Synthroid which I have also taken in the past. I also take natural estrogen, progesterone, testosterone and DHEA. I am post-menopausal and I feel much better now that I am taking these natural medications.
Thanks,
Shirley Roberts
04/22/2008
Helena Kojac
United States
Doctors please listen to us, as we know our bodies better than anyone else! Testosterone is a needed and declining hormone in the aging women and man! We need to get back to our levels of testoserone when we were young.
06/09/2007
Carolyn Elmore
United States
I suffered from major anxiety for years after a minor surgery destroyed my female hormones in my ovaries. Bio Identical has saved my life and made me feel normal and happy again.
05/27/2007
Vanessa Hughes
Switzerland
(no comment)

 

 

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