Testosterone use in women

The role of testosterone in women and its potential as a therapeutic agent continues to attract controversy. Testosterone levels in women decline with age from the mid-reproductive years, and are low in women who have experienced surgical menopause, premature ovarian failure and hypopituitarism. The primary outcome of clinical trials on the effects of testosterone in women has been on treatment of female sexual dysfunction; notably that characterized by loss of sexual desire. There is substantial evidence that judicious testosterone therapy is effective for the treatment of loss of sexual desire in postmenopausal women and women approaching the late reproductive years, as well as women with ovarian or pituitary failure, with doses given that achieve circulating levels close to the physiological range for young reproductive women. The greatest body of clinical data is from studies of transdermal testosterone in postmenopausal women. The link between postmenopausal estrogen-progestin use and both breast cancer and cardiovascular disease has created a level of concern regarding any form of hormone use in women. Objective data show no adverse cardiovascular effects of transdermal testosterone therapy, and cumulative data from RCTs do not indicate increased cancer risk in women treated with testosterone. A recent Cochrane Review (Somboonporn et al. 2005) has thoroughly evaluated the evidence for the effects of testosterone added to estrogen therapy in postmenopausal women. This chapter reviews the physiology of testosterone in women, summarizes the findings from observational studies and clinical trials, and considers indications for use.