Testosterone for Women – Treatment

The majority of female patients with testosterone deficiency exhibit reduced sexual drive and/or unexplained lethargy and fatigue and/or altered mood.

Management requires a multidisciplinary, integrated approach. This should be co-ordinated by a suitably trained medical practitioner.

  • Specific medical conditions such as iron deficiency, abnormal bleeding, diabetes, depression and thyroid disease require addressing before considering hormonal therapies.
  • Lifestyle changes such as exercise, smoking, alcohol intake and weight loss need to be reviewed.
  • Vaginal lubricants provide symptomatic relief for vaginal dryness and dyspareunia (difficult or painful sexual intercourse). Localized estrogen pessaries, vaginal tablets, creams and gels can also assist.
  • Pelvic floor physiotherapy will improve vaginal muscle tone and muscle associated with orgasm, and in managing incontinence.
  • Alteration of prescribed medications which may interfere with sexual function if appropriate. Especially oral hormone replacement therapy (HRT), oral contraceptives (OC’s) and antidepressants.Medications which may interfere with sexual desire include:

 

Medication Use
SSRI’s, tricyclics Depression
Oral oestrogens Oral contraceptive pill, HRT
Medroxyprogesterone Contraceptive, HRT
Clonidine Hot flushes
Medroxyprogesterone Contraceptive, HRT
Spironolactone, Androcur Hirsutism
Danazol Endometriosis
Benzodiazepines Anxiety, insomnia
Beta blockers Hypertension
H2 antagonists Oesophageal reflux
Ketoconazole Vuvlo-vaginal candidiasis
Gemfibrazol Hyperlipidaemia

 

Under no circumstances should patients change or cease taking medications without the consent of their doctor. If a patient is taking one or more of these medications and experiencing a lowered sexual desire he or she should consult their medical practitioner.

A medical practitioner’s assessment of a patient must include:

Medical History, Including Sexual History


It is very important that a doctor be skilled in discussing, understanding and managing problems associated with sexual matters. In terms of a sexual history it is vital that the practitioner knows his or her limits. If the doctor has little or no training in sexual counselling a referral to a trained sex counsellor is recommended.

A doctor should:

  • not be judgemental due to his or her own sexual prejudices or “hang-ups”
  • ensure that the patient understands the issue of doctor-patient confidentiality
  • be sensitive and optimistic when dealing with relationship issues
  • encourage consultation with partner present
  • allow extended time for consultations
  • understand that problems may not be revealed without specific enquiry
  • understand that sensitive and embarrassing issues may not be readily volunteered

It is very important that a doctor be skilled in discussing, understanding and managing problems associated with sexual matters.

Examination

It is important that a general “good female health” check be undertaken by your doctor.

Routine screening should include: mammogram, Pap smear, cardiovascular parameters, fasting blood glucose, serum thyroid stimulating hormone (TSH), full blood examination and iron studies.

Further specific investigations of specific medical disorders such as abnormal bleeding, breast lump(s), incontinence and osteoporosis are essential before any consideration of testosterone treatment.

Psychological evaluation of mood, well-being and sexual function may need to be conducted.

Hormone Blood Testing

The measurement of testosterone levels in the blood provides a snapshot of what is the status of the person at the time of taking blood.

Testosterone secretion follows a diurnal rhythm in females. That is, it rises and falls over a 24 hour period. It’s production occurs during the night and early morning with levels highest on waking. The serum levels slowly decrease during the day and are lowest in the late afternoon and early evening.

Therefore blood samples should preferably be taken in the morning, when hormones levels are at their highest. Individual variations in serum testosterone levels can occur due to time of day, medication usage, stress, illness or recent surgery.

The ovaries and adrenal glands do not store testosterone. Once produced it is secreted into the blood stream where it is rapidly adhered to by the protein sex hormone binding globulin (SHBG), is a transporter protein found in the blood. It acts as a carrier to move hormones around the body. Up to 99% of testosterone produced is bound to SHBG.

The testosterone which are not attached to the SHBG is the only hormone that is free to act throughout the body.

Some doctors will measure only testosterone levels (called total testosterone) and not take into account the SHBG levels. While not technically wrong, total testosterone measurement alone is not the most accurate representation of how much it is free to act in the body. As a consequence the total hormone reference ranges commonly adopted by pathology laboratories for determination of “normal” and “low” testosterone are potentially misleading, because the results do not take into account the effects of SHBG.

SHBG is elevated with ageing, smoking, high alcohol intake, insulin, oral estrogens and some medications.

In order to establish an accurate diagnosis for a patient it is essential to measure the “free androgen index” or FAI. This is calculated by the total testosterone level in the blood divided by the SHBG level multiplied by 100.

Generally, a FAI reading of 2 or less is a strong indication that testosterone supplementation is warranted. Other factors such as pre-existing illnesses, physical, hormonal, psychological and mental health must be taken into account before using testosterone.

Testosterone and SHBG levels are essential in the assessment of androgen insufficiency as a cause of loss of libido, mood and well-being. These measures are important regardless of menopausal status, age or ethnic background.

Testosterone Treatment Options

The majority of patients with low testosterone levels exhibit reduced sexual drive, altered mood and unexplained lethargy and fatigue.

As discussed earlier, injections and implants have largely been superseded by products designed for delivering physiological doses for use in women. These products are:

Intrinsa® Transdermal Testosterone Patch (Procter and Gamble, USA)

The testosterone patch is yet to be approved by the USA Food and Drug Administration (FDA) or the Australian Therapeutic Goods Administration (TGA). Intrinsa®. has been approved by the European Agency for the Evaluation of Medicinal Products (EMEA), but is yet to be released onto the USA or Australian market. Cost in the UK is around €100 (USD$170) for a 1 month supply.

TestoFeme Plus Natural 1% Testosterone cream for Women (Affiliates International, Australia
TestoFeme Plus Natural 1% Testosterone cream for Women has been available in Australia since 1998 and is currently the only available approved testosterone product available for delivering  safely and effectively to women. Testofeme is applied topically to the inner thighs, arms or lower abdomen once daily. The dose is titratable and the usual dose is 1-2cm (5-10mg testosterone) daily (measurer included). Cost is USD$50 for a 6-12 weeks supply.