Testosterone levels in women decline steeply with age during the reproductive years; by the time women reach their late 40, their blood testosterone levels are approximately half what they were in their 20s.[1, 2]
Symptoms of androgen deficiency, including a reduced sense of well-being, dysphoric mood (sadness, depression, anxiety, and irritability), fatigue, decreased libido, hot flashes, bone loss, decreased muscle mass and strength, changes in cognition and memory, and insomnia may occur prior to cessation of menses. Pre-menopausal patients frequently report ‘menopausal symptoms’, most of which are not related to estradiol levels.
Adding testosterone to estrogen therapy in postmenopausal women has beneficial cardiovascular effects and also results in meaningful improvements in sexual function in women not taking estrogen.
Testosterone supplementation in both pre- and postmenopausal women has been shown safe, even in higher doses[7, 8], and shown not to affect the menstrual cycle. It is increasingly used as part of postmenopausal HRT (hormone replacement therapy) regimens. Contrary to old beliefs, testosterone can actually protect against breast cancer. It has been shown that addition of testosterone may counteract breast cell proliferation induced by estrogen/progestogen therapy in postmenopausal women.[11-15]
A notable study investigated the effectiveness of a 3 month continuous testosterone therapy, delivered by subcutaneous implant, on the relief of somatic, psychological and urogenital symptoms in both pre- and post-menopausal patients using the self administered Health-Related Quality of Life (HRQOL) questionnaire called the Menopause Rating Scale (MRS).
A study in a large primary care patient population shows that low baseline testosterone in women aged 43-72 years is associated with increased all-cause mortality and cardiovascular events. This association was found to be largely independent of traditional risk factors, and supports the notion that the hormonal status in middle age and older women might impact morality outcomes.
The objective of the study was to determine whether baseline testosterone levels in women are associated with future overall or cardiovascular morbidity and mortality.