LAUSR

· Is testosterone a female hormone? ◦ Yes, premenopausal women produce both testosterone and estrogen physiologically. ◦ Androgens, including testosterone, are essential for development and maintenance of female sexual anatomy and physiology, and modulation of sexual behavior. · What happens to testosterone levels with age? ◦ The decline in testosterone levels appears to be age related at least partly due to loss of ovarian function but can also occur more profoundly due to iatrogenic menopause which may be medical or surgical. · Should testosterone be replaced just because levels are low? ◦No.Many women with low systemic testosterone levels do not complain of distressing low libido or other symptoms, even on direct questioning. · Why do systemic testosterone levels not always correlate directly with hypoactive sexual desire disorder (American Psychiatric Association’s definition of distressing low libido)? ◦ The intracrinological metabolism of testosterone may be more important than the circulating levels. ◦ This may be particularly important in the central nervous system where DHEA is converted to testosterone in the brain. · Who should be offered testosterone? ◦ Testosterone supplementation should only be considered in women who complain of low sexual desire after a biopsychosocial approach has excluded other causes such as relationship, psychological and medicationrelated HSDD, for example, SSRIs/SNRIs. ◦ However, combined hormonal and psychosexual approaches may be beneficial in cases with mixed etiologies. · Should testosterone be prescribed on its own or with HRT? ◦ The NICE Menopause Guideline (NG23) and the BMS recommend that a trial of conventional HRT is given before testosterone supplementation is considered. ◦ Oral estrogens, especially conjugated estrogens, can reduce the effectiveness of testosterone by increasing sex hormone binding globulin levels. Switching women with HSDD from oral to transdermal estrogen can be beneficial as this can increase the proportion of circulating free testosterone without requiring exogenous testosterone. ◦ It is important that any symptoms of vulvovaginal atrophy are also adequately treated if testosterone is being considered for HSDD. ◦ Although studies have shown that testosterone can be beneficial in women not using concomitant estrogen containing hormone therapy, the incidence of adverse androgenic effects such as acne and excess hair growth is higher; this strategy is therefore not usually recommended in routine clinical practice. · What about the potential wider benefits of testosterone? ◦ Randomized clinical trials of testosterone to date have not demonstrated the beneficial effects of testosterone therapy for cognition, mood, energy, and musculoskeletal health. ◦ Further better designed studies are required with these health issues as primary outcome measures as some individuals report improvement of these symptoms. ◦Until these data are available, the primary indication for testosterone should therefore be for HSDD following a biopsychosocial approach. · Are there side effects and risks? ◦ Adverse effects of testosterone in women are uncommon if levels are maintained within the female physiological range. ◦ The commonest are excess hair growth, acne, and weight gain which are usually reversible with reduction in dosage or discontinuation.