Our Perspective on Testosterone Replacement for Women

Our Perspective on Testosterone Replacement for Women

At Modern Age, we strongly believe in the importance of supporting optimal testosterone levels in order to promote overall well-being as well as prevent different chronic diseases for women. However, conventional medical standards currently dictate that testosterone therapy should not be prescribed to women - only in the very specific case of diagnosed hypoactive sexual disorder/dysfunction (HSDD) in women. We believe that a much broader group of people can benefit from testosterone therapy, based on our experience and our interpretation of the available literature. Accumulating research suggests there are benefits for women when testosterone therapy is used appropriately, despite the controversy associated with the medication.

For women, testosterone is not exclusively a “male” hormone. Testosterone is the most abundant biologically active hormone throughout a woman’s lifespan, present at higher levels than estrogen until age 50 (Dimitrakakis et al., 2002). However, testosterone levels decline with age, and lower levels correlate with reduced libido, sexual function, bone density, muscle mass, energy, and psychological well being (Guay et al., 2004; Turna et al., 2005).

Multiple studies suggest testosterone therapy can provide benefits for women. A randomized controlled trial found testosterone improved sexual satisfaction scores in premenopausal women with low libido (Davis et al., 2008). Another trial reported testosterone pellets reduced menopausal symptoms like insomnia, fatigue, low libido, and cognitive decline in 60% of deficient women (Cardoza et al., 1984). An 8-year observational study observed a significant reduction in breast cancer incidence in postmenopausal women using testosterone therapy (Dimitrakakis et al., 2004). Testosterone also appears protective for the heart. Lower testosterone levels correlate with increased carotid atherosclerosis in women, while higher testosterone correlates with lower cardiovascular risk (Debing et al., 2007; Golden et al., 2002). Testosterone acts as a vasodilator and has anti-inflammatory effects in the vasculature (Jones & Saad, 2009). In congestive heart failure patients, testosterone improved exercise capacity, insulin resistance, and muscle strength in women (Iellamo et al., 2010).

For cognition, testosterone replacement improved verbal learning and memory in postmenopausal women in one pilot study (Davison et al., 2011). Animal studies also observed neuroprotective effects of testosterone on neuron morphology and lifespan (Ramsden, 2003). Spatial cognition and navigational ability correlate with testosterone levels in women (Aleman et al., 2004).

For bone health, lower testosterone levels are associated with reduced bone mineral density and increased hip fractures in women (Slemenda et al., 1990; Davidson et al., 1988). Testosterone combined with estrogen led to greater increases in bone density than estrogen alone postmenopausally (Davis et al., 1995).

Importantly, testosterone also does not appear to create disease risks. Testosterone does not appear to raise cardiovascular risks or breast cancer. Large studies found testosterone did not adversely affect lipid profiles, liver function, or clotting factors (Davis et al., 2008), and there was no increase in cardiovascular events or breast cancer compared to controls (van Staa & Sprafka, 2009).

While some studies raised concerns about cardiac risk, a meta-analysis found no increased risk of cardiovascular events with testosterone therapy (Haddad et al., 2007). The TOM trial, which was halted due to cardiovascular events, had methodological flaws and failed to show increased event rates with statistical significance (Basaria et al., 2010). The retrospective VA study claiming increased heart attacks with testosterone relied heavily on statistics to overturn very low raw event rates (Vigen et al., 2013).

In summary, a growing body of research suggests testosterone therapy provides benefits for women when appropriately prescribed for documented testosterone deficiency. Well-designed studies have not observed increased cardiovascular or breast cancer risks. However, more research is still needed to better characterize its effects long-term. Present data indicates testosterone is underutilized as a safe hormone therapy when correctly implemented and monitored. We believe in this therapy at Modern Age and its ability to help improve the daily lives of women when prescribed and monitored appropriately.

References:

Araujo, A.B., Dixon, J.M., Suarez, E.A., Murad, M.H. & Guey, L.T. (2011). Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis. Journal of Clinical Endocrinology & Metabolism, 96(10), 3007-3019.

Aleman, A., Bronk, E., Kessels, R.P.C., Koppeschaar, H.P.F. & van Honk, J. (2004). A single administration of testosterone improves visuospatial ability in young women. Psychoneuroendocrinology, 29(5), 612-617.

Basaria, S., Coviello, A.D., Travison, T.G., Storer, T.W., Farwell, W.R., Jette, A.M., Eder, R., Tennstedt, S., Ulloor, J., Zhang, A. & Choong, K. (2010). Adverse events associated with testosterone administration, New England Journal of Medicine, 363(2), 109-122.

Buvat J., Maggi M., Guay A. & Torres L.O. (2013). Testosterone deficiency in men: systematic review and standard operating procedures for diagnosis and treatment. Journal of Sexual Medicine, 10(1), 245-284.

Cardoza, L., Gibb, D.M., Tuck, S.M., Thom, M.H., Studd, J.W. & Cooper, D.J. (1984). The effects of subcutaneous hormone implants in the climacteric. American Journal of Obstetrics and Gynecology, 5, 177-184.

Davison, S.L., Bell, R.J., Gavrilescu, M., Searle, K., Maruff, P., Gogos, A., Rossell, S.L., Adams, J. & Davis, S.R. (2011). Testosterone improves verbal learning and memory in postmenopausal women. Results from a pilot study. Maturitas, 70(3), 307-311.

Davis, S.R., Moreau, M., Kroll, R., Bouchard, C., Panay, N., Gass, M., Braunstein, G.D., Hirschberg, A.L., Rodenberg, C., Pack, S., Koch, H., Moufarege, A. & Studd, J. (2008). Testosterone for low libido in postmenopausal women not taking estrogen. New England Journal of Medicine, 359(19), 2005-2017.

Davis, S.R., McCloud, P., Strauss, B.J.G. & Burger, H. (1995). Testosterone enhances estradiol’s effects on postmenopausal bone density and sexuality. Maturitas, 21(3), 227-236.

Debing, E., Peeters, E., Duquet, W., Poppe, K., Velkeniers, B. & Van den Brande, P. (2007). Endogenous sex hormone levels in postmenopausal women undergoing carotid artery endarterectomy. European Journal of Endocrinology, 156(6), 687-693.

Dimitrakakis, C., Jones, R., Liu, A. & Bondy, C. (2004). Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy. Menopause, 11(5), 531-535.

Golden, S.H., Maguire, A., Ding, J., Crouse, J.R., Cauley, J.A., Zacur, H. & Szklo, M. (2002). Endogenous postmenopausal hormones and carotid atherosclerosis: a case-control study of the atherosclerosis risk in communities cohort. American Journal of Epidemiology, 155(5), 437–445.

Guay, A.T., Munarriz, R., Jacobson, J., Talakoub, L., Traish, A., Quirk, F., Goldstein, I. & Spark, R. (2004). Serum androgen levels in healthy premenopausal women with and without sexual dysfunction: Part A. Serum androgen levels in women aged 20–49 years with no complaints of sexual dysfunction. International Journal of Impotence Research, 16(2), 112-120.

Haddad, R.M., Kennedy, C.C., Caples, S.M., Tracz, M.J., Boloña, E.R., Sideras, K., Uraga, M.V., Erwin, P.J. & Montori, V.M. (2007). Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clinic Proceedings, 82(1), 29-39.

Iellamo, F., Volterrani, M., Caminiti, G., Karam, R., Massaro, R., Fini, M., Collins, P. & Rosano, G.M.C. (2010). Testosterone therapy in women with chronic heart failure: a pilot double-blind, randomized, placebo-controlled study. Journal of the American College of Cardiology, 56(16), 1310-1316.

Jones, T.H. & Saad, F. (2009). The effects of testosterone on risk factors for, and the mediators of, the atherosclerotic process. Atherosclerosis, 207(2), 318-327.

Makinen, J., Jarvisalo, M.J., Pollanen, P., Perheentupa, A., Irjala, K., Koskenvuo, M., Makinen, J., Huhtaniemi, I., Raitakari, O. & Juvonen, T. (2005). Increased carotid atherosclerosis in andropausal middle-aged men. Journal of the American College of Cardiology, 45(10), 1603-1608.

Malkin, C.J., Pugh, P.J., Morris, P.D., Kerry, K.E., Jones, R.D., Jones, T.H. & Channer, K.S. (2006). Testosterone replacement in hypogonadal men with angina improves ischaemic threshold and quality of life. Heart, 90(8), 871-876.

Morgentaler, A., Zitzmann, M., Traish, A.M., Fox, A.W., Jones, T.H., Maggi, M., Arver, S., Aversa, A., Chan, J.C., Dobs, A.S. & Hackett, G. (2016). Fundamental Concepts Regarding Testosterone Deficiency and Treatment: International Expert Consensus Resolutions. Mayo Clinic Proceedings, 91(7), 881-896.

Ramsden, M., Shin, T.M. & Pike, C.J. (2003). Androgens modulate neuronal vulnerability to kainate lesion. Neuroscience, 122(3), 573-578.

Ruige, J.B., Mahmoud, A.M., De Bacquer, D. & Kaufman, J.M. (2011). Endogenous testosterone and cardiovascular disease in healthy men: a meta-analysis. Heart, 97(11), 870-875.

Slemenda, C.W., Hui, S.L., Longcope, C. & Johnston, C.C. Jr. (1990). Predictors of bone mass in perimenopausal women. A prospective study of clinical data using photon absorptiometry. Annals of Internal Medicine, 112(2), 96-101.

Turna, B., Apaydin, E., Semerci, B., Altay, B., Cikili, N. & Nazli, O. (2005). Women with low libido: correlation of decreased androgen levels with female sexual function index. International Journal of Impotence Research, 17(2), 148-153.

Van Staa, T.P. & Sprafka, J.M. (2009). Study of adverse outcomes in women using testosterone therapy. Maturitas, 62(1), 76-80.

Vigen, R., O'Donnell, C. I., Barón, A. E., Grunwald, G. K., Maddox, T. M., Bradley, S. M., Barqawi, A., Woning, G., Wierman, M. E. & Plomondon, M. E. (2013). Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA, 310(17), 1829-1836.