Menopause, a natural biological process marking the end of a woman’s menstrual cycle, is often accompanied by a range of physical and emotional symptoms due to hormonal changes. Among the various treatment options available, testosterone therapy has garnered attention for its potential benefits and risks. Dr. James Al Simon is an internationally renowned expert on testosterone in women having published and lectured extensively on this subject. See a small subset of his publications and videotaped lectures here:
Benefits of Testosterone Therapy
1. Improved Sexual Function: One of the primary reasons menopausal women consider testosterone therapy is to alleviate sexual dysfunction. Studies have shown that testosterone can improve libido, sexual arousal, orgasm, and satisfaction with sex in women who experience hypoactive sexual desire disorder (HSDD) a medical diagnosis meaning “low sex drive and concern about it lasting 6 months or more”. A meta-analysis published in *The Lancet Diabetes & Endocrinology* highlighted significant improvements in sexual desire, pleasure, and orgasm frequency among women receiving testosterone therapy compared to those receiving a placebo (Islam et al., 2019).
2. Enhanced Mood and Well-being: Testosterone is known to play a role in mood regulation. Some research suggests that testosterone therapy can reduce symptoms of depression and improve overall well-being in menopausal women. A study in the *Journal of Clinical Endocrinology & Metabolism* reported that women undergoing testosterone therapy experienced notable improvements in mood and psychological well-being (Davis et al., 2018).
3. Increased Muscle Mass and Bone Density: Testosterone is crucial for maintaining muscle mass and bone density. The differences in testosterone levels between men and women are largely responsible for the differences in the size and strength of muscles and bone density between the genders. During menopause, the decline in estrogen levels contributes to the loss of bone density and muscle strength. Testosterone, which has been declining slowly and progressively in women since about age 30 years, aggravates these changes. Testosterone therapy has been shown to counteract these effects, promoting muscle growth and enhancing bone mineral density. This can be particularly beneficial in reducing the risk of osteoporosis and related fractures (Shifren et al., 2019).
Risks of Testosterone Therapy
1. Cardiovascular Concerns: One of the significant risks associated with testosterone therapy is its potential impact on cardiovascular health. Elevated testosterone levels above the normal physiological range have been linked to an increased risk of cardiovascular events, such as heart attacks and strokes. A study published in the *Journal of the American Medical Association* found that women undergoing testosterone therapy had a higher incidence of cardiovascular events compared to those not receiving the therapy (Vigen et al., 2013), but a recent FDA-mandated study because of similar concerns in men, using much higher doses of testosterone in older men documented safety for these same cardiovascular endpoints (Bhasin S, et. al 2022).
2. Hirsutism, Acne and Balding: Testosterone therapy can lead to unwanted physical changes, such as hirsutism (excessive facial and body hair), acne, and balding. These side effects result from the androgenic properties of testosterone, which can stimulate hair follicles on the face and other sexual hair areas (armpits, legs, and bikini area. etc.), and sebaceous glands, those oil-producing glands of the skin that you remember from your teenage years. For many women, these side effects can recur when using testosterone, be distressing, and impact their quality of life (Panay et al., 2020).
3. Liver Toxicity: Some oral testosterone preparations have been associated with liver toxicity. Although less common with low doses, and non-oral routes of administration, this remains a concern for women considering testosterone therapy. Monitoring liver function tests is essential to mitigate this risk (Rosner et al., 2016).
4. Impact on Lipid Profile: Testosterone therapy can negatively affect lipid profiles, increasing low-density lipoprotein (LDL-the bad stuff) cholesterol and reducing high-density lipoprotein (HDL-the good stuff) cholesterol levels. This alteration in lipid metabolism can elevate the risk of developing atherosclerosis and other cardiovascular diseases. These lipid changes are both dose and route of administration dependent. (Ganesan et al., 2015).
Conclusion
Testosterone therapy offers several benefits for menopausal women, including improved sexual function, enhanced mood, and increased muscle mass and bone density. However, it also carries risks, such as cardiovascular concerns, hirsutism, acne, balding, liver toxicity, and adverse effects on lipid profiles. Therefore, it is crucial for women considering testosterone therapy to undergo a thorough evaluation and discuss these potential benefits and risks with their healthcare professional to make an informed decision tailored to their individual needs and health status. Testosterone therapy in perimenopausal and menopausal women is a significant medical art form requiring special knowledge and experience. It is not for amateurs or the latest YouTube or Tik Tok self-proclaimed expert.
References
– Davis, S. R., Moreau, M., Kroll, R., Bouchard, C., Panay, N., Gass, M., … & Studd, J. (2018). Testosterone for low libido in postmenopausal women not taking systemic estrogen therapy. *Journal of Clinical Endocrinology & Metabolism, 93*(3), 1683-1692.
– Ganesan, K., Teklehaimanot, S., Norris, K. C., & Harman, S. M. (2015). Cardiovascular effects of testosterone therapy in elderly men. *Cardiovascular Endocrinology, 4*(2), 91-97.
– Islam, R. M., Bell, R. J., Green, S., & Davis, S. R. (2019). Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomized controlled trial data. *The Lancet Diabetes & Endocrinology, 7*(10), 754-766.
– Panay, N., Al-Azzawi, F., Bouchard, C., Davis, S. R., Eden, J., Lodhi, I., … & Stevenson, J. (2020). Testosterone treatment of HSDD in naturally menopausal women: the ADORE study. *Climacteric, 23*(5), 499-507.
– Rosner, W., Auchus, R. J., Azziz, R., Sluss, P. M., & Raff, H. (2016). Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. *Journal of Clinical Endocrinology & Metabolism, 92*(2), 405-413.
– Shifren, J. L., Gass, M. L., & NAMS Recommendations for Clinical Care of Midlife Women Working Group. (2019). The North American Menopause Society recommendations for clinical care of midlife women. *Menopause, 21*(10), 1038-1062.
– Vigen, R., O’Donnell, C. I., Barón, A. E., Grunwald, G. K., Maddox, T. M., Bradley, S. M., … & Ho, P. M. (2013). Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. *Journal of the American Medical Association, 310*(17), 1829-1836.
-Bhasin S, Lincoff AM, Basaria S, et. al. for the TRAVERSE Study Investigators (2022). Effects of long-term testosterone treatment on cardiovascular outcomes in men with hypogonadism: Rationale and design of the TRAVERSE study. Am Heart J. 2022 Mar;245:41-50.
