What's the Deal with Testosterone in Menopause?

What’s the deal with testosterone and menopause? Do we need it? Is it dangerous? Is it the answer to all of our symptoms? Let’s look at the evidence to see what we know and don’t know about testosterone and menopause…

Does It HELP?

Low libido

Hypoactive Sexual Desire Disorder (HSDD), which is part of what is now called Female Sexual Interest and Arousal Disorder (FSIAD), is basically just low libido that is bothersome and is not due to a medical condition, medication, mental health/mood issues, or relationship issue. This has been consistently shown in clinical studies to be successfully treated by transdermal testosterone.

Many studies have shown that transdermal testosterone can improve libido (treat HSDD) in postmenopausal women whether or not they are on menopausal hormone therapy (estrogen and/or progesterone). The ADORE study included 272 naturally menopausal women, some of whom were on hormone therapy and some of whom were not. They were given a 300mcg testosterone patch for low libido/HSDD or placebo. The women who used the testosterone patch (both those on hormone therapy and those who were not) reported more satisfying sexual episodes, increased sexual desire, increased arousal, increased sexual pleasure, improved self-image, decreased personal distress, and decreased sexual concerns compared to those receiving placebo. It has also been shown to improve sexual desire and overall sexual functioning in women with surgical menopause (after having their ovaries surgically removed). The Menopause Society and other national professional societies recommend transdermal testosterone for only this indication (treatment of low libido). Fatigue and Mood

Although there are fewer studies on the use of testosterone in perimenopausal and postmenopausal women to improve mood and fatigue, there is some evidence that it is helpful for these symptoms. Unlike low libido, however, the studies are mixed. In one study of 510 women in the UK who were being treated with tesosterone for low libido, the women reported improved mood and cognition while on they were on testosterone gel for 4 months compared to when they were estrogen and progesterone but not testosterone. A small study of perimenopausal women in their 40's given transdermal testosterone for libido also reported improvement in mood and overall feelings of wellbeing. However, another study of women with premature menopause did not show any improvement in quality of life, mood, or self-esteem when testosterone was added to estrogen + progesterone therapy.

Hot Flashes and Night Sweats

Testosterone does not seem to be effective for treating hot flashes and night sweats. Estrogen is the most effective hormone for treatment of hot flashes and night sweats with higher dose of progesterone helping a bit.

Is It SAFE?

Form of Testosterone & Levels

Although the form of testosterone used in the clinical studies was a patch, this did not gain FDA approval (not due to an issue with safety). There is currently no FDA approved form of testosterone for women. The safest form of testosterone is still a transdermal form, either a gel or cream. As the only FDA approved forms of testosterone are for men, these can either be used at 1/10th of the male dose, or a cream can be compounded by a compounding pharmacy. Levels should be checked about 4-6 weeks after starting therapy and after each change in dose. It is important to keep levels within the normal premenopausal female range. When testosterone levels are in this physiologic range, there is no concern about safety (though long term data are not available). A large trial called the APHRODITE trial looked at side effects, and the only side effect common when levels are kept in the normal range is mild facial hair growth. Other forms of testosterone such as injections and pellets are not recommended because they usually result in supraphysiologic (really high) levels. These high levels can result in side effects, some of which can be irriversible -- cystic acne, facial and body hair growth, male pattern hair loss, deepening of the voice, growth of the clitoris, anger and mood changes, and even higher cholesterol levels. Transdermal testosterone in physiologic doses does not affect cholesterol levels.

Should I Check My Levels?

In general, there is no need to have hormone levels checked before you start menopausal hormone therapy of any kind. We choose to start testosterone therapy to treat symptoms, usually low libido. We choose to start estrogen and progesterone therapy to treat other menopausal symptoms (hot flashes, night sweats, sleep issues, brain fog, joint pain). We do not base hormone therapy on "low" blood levels. If we need to start tesosterone therapy, we may get a baseline level to see where we are starting from. Unlike estrogen and progesterone, testosterone levels do need to be checked during therapy to ensure that the levels are not getting too high! We don't want to turn you into a man!

Bottom Line: Testosterone can be a safe and effective treatment for low libido in perimenopause and menopause. It may also help with mood and overall well-being. Safe ways to use testosterone are transdermal gels and creams in 1/10th of the male dose, and levels should be monitored to ensure that they stay within the normal premenopausal female range to avoid side effects. In these physiologic dosages, there are few side effects and no adverse health effects.

Do You Need a Rx?

Testosterone is a controlled substance, so everyone does not prescribe it, and you often cannot get it online. I am licensed to prescribe testosterone in every state where I see patients. I am happy to help.

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Have a question for me or an idea for my Blog? Feel free to reach out! contact@jackiestonemd.com

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