Testosterone for women

Examples

Generic Name	Brand Name
Methyltestosterone and esterified estrogens	Estratest, Estratest H.S.

Oral estrogen-methyltestosterone, such as Estratest, is marketed for moderate to severe menopausal symptoms that have not improved with estrogen alone and for menopausal women to improve sexual desire and response.

But methyltestosterone with estrogen is not approved by Health Canada's Therapeutic Products Directorate (TPD) for any medical use.

How It Works

Testosterone is known as a "male" hormone, or androgen. It also is made in small amounts by a woman's adrenal glands and ovaries. A woman's testosterone is highest around age 20 and slowly declines till it is half as high in her 40s.¹

• In men, testosterone is linked to male physical traits and sex drive.
• In women, testosterone may be linked to sex drive. But for women, interest in sex is much more complicated than just testosterone levels.

Testosterone therapy raises testosterone levels in the body. But, testosterone without added estrogen is only TPD-approved for use in men. In women, it may improve sex drive, but it can cause male-type physical traits when taken in too high a dose. Many doctors are hopeful that a safe, low-dose testosterone will be available for women in the future.

Methyltestosterone probably does not work in the body and the brain like natural testosterone does. It does not directly raise a woman's testosterone levels, and it cannot be measured in the blood like natural testosterone. But taking methyltestosterone does seem to free up some of the body's natural testosterone. This may be why some women have more sex drive when taking a low dose of methyltestosterone.²

Why It Is Used

Methyltestosterone and testosterone treatment for women have not been well studied and are not approved by the TPD. Studies of testosterone in women have not lasted longer than 6 months. TPD experts want to know more about long-term risks before they approve testosterone for female use.

Methyltestosterone. The company that makes Estratest markets it for moderate to severe menopausal symptoms that have not improved with estrogen alone. This hormone product is marketed to menopausal women for improving sexual desire and response. Methyltestosterone with estrogen is not approved by Health Canada's Therapeutic Products Directorate (TPD) for any medical use.

Testosterone is an experimental treatment used to raise a woman's sexual interest, arousal, and satisfaction. Women with low androgen levels who might benefit from low-dose testosterone therapy include those who:

• Have had their ovaries removed (oophorectomy). This causes a sudden drop in testosterone, which may decrease sex drive and satisfaction.
• Have a low sex drive that does not seem to be caused by a medicine, nor by relationship or stress-related problems.
• Have an adrenal system problem or an underactive pituitary gland (hypopituitarism).

Do not take testosterone if you:¹

• Could become pregnant. Taking testosterone while you are pregnant can cause a female fetus to develop male traits.
• Have or have had breast or uterine cancer.
• Have high cholesterol or heart disease.
• Have liver disease.

Some experts advise against using testosterone therapy for women who have not reached menopause.³ If you use testosterone and could become pregnant, be sure to use highly effective birth control.

How Well It Works

There is not strong enough evidence to support the use of testosterone for improving menopausal symptoms.¹

In many women, testosterone may have a direct effect on sex drive and sexual response. Women taking testosterone may have more sexual thoughts, fantasies, activity, and satisfaction.⁴

There is no solid link between a woman's high testosterone and high sex drive, nor between low sex drive and low testosterone. You can have a low testosterone level in your body and have a normal sex drive or have high testosterone and very little interest in sex.

Side Effects

In women, long-term testosterone side effects have not been studied.¹ Experts know that:

• Oral testosterone lowers "good" HDL cholesterol and raises "bad" LDL cholesterol in the blood. High cholesterol is known to increase risks of heart disease and stroke.¹ This is why experts want to know more about long-term oral testosterone therapy.
• Testosterone should not be taken during pregnancy because it affects a growing fetus.

Testosterone treatment for longer than 6 months has not been studied. Experts do not yet know whether it raises risks of breast cancer, heart disease, or dangerous blood clots. It may increase these risks, because some testosterone in the body is made into estrogen. Higher-than-normal estrogen in the body is linked to these risks.¹

The goal of testosterone treatment is to raise a woman's testosterone level no higher than what is normal for a young woman. All current testosterone products are made for dosing in men. There is not yet a standard dose or blood test for women, so dosing is adjusted based on your symptoms. You are taking a dose that is too high if you have:

• Acne or oily skin.
• Male-pattern hair loss from the scalp.
• Male-pattern hair growth on the face and body.
• Anger and hostility problems.
• Shrinking breast size.
• Hoarseness or a deeper voice. (This is the one side effect that may not go away after you stop testosterone treatment.)
• Irregular menstrual cycles, if you have been menstruating.
• An increase in the size of your clitoris.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Taking testosterone by using a skin patch, gel, or cream does not seem to affect cholesterol levels, but taking it by mouth does. This is because hormones are processed through the liver when taken by mouth, but not when they are taken through the skin.¹ But, there are no such TPD-approved testosterone products for women at this time.

Some women go to a compounding pharmacist for "bioidentical" hormone remedies.

• Risks of bioidentical hormones are not known to be any different than risks of hormones made by a pharmaceutical company.⁵
• Many compounded hormone remedies for menopausal symptoms include testosterone. Talk to your health professional about testosterone risks before using any remedy with testosterone in it.

Many other supplements may interact with testosterone. Be sure to tell your health professional about any non-prescription medicines, supplements, or herbs you are taking.

An overdose of androgens may cause seizures, hepatitis, problems with blood clot formation, or other serious health problems. Taking DHEA and testosterone together may be dangerous. (DHEA is an androgenic dietary supplement that is derived from the wild yam. It is also called prasterone in the United States. DHEA is not available in Canada.)

Testosterone should not be taken during pregnancy because it affects a growing fetus. If you use testosterone and could become pregnant, use highly effective birth control.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Author:	Kathe Gallagher, MSW Carrie Henley	Last Updated: July 31, 2006
Medical Review:	Adam Husney, MD - Family Medicine Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
© 1995-2008 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.