Testosterone

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 Whilst oestrogen is the main hormone produced from the female ovary, testosterone is also important and is produced from the seroma of the ovaries in the premenopausal years. As the ovaries begin to fail and hormones reduce, testosterone levels also decline in tandem with oestrogen. Whilst falling or low testosterone may not be noticed in some women in others it can lead to symptoms including:

• Loss of energy/fatigue
• Low mood
• Low libido/sex drive
• Reduced sexual response if intercourse is attempted
• Connective tissue weakening eg. Lax joints, weak muscles
• Loss of endurance to exercise
• Poor response to exercise

Many women report that testosterone supplementation improves mood, energy, sex drive and response to sexual intercourse (ability to orgasm). It can also have a complementary effect to oestrogen if taken as part of HRT either topically (pessaries or cream to improve pelvic floor symptoms) or general HRT. Some literature suggests testosterone reduces breast cell division which may have a beneficial effect on breast cancer protection although no long-term studies are available. However, there are no studies indicating an increased risk of breast cancer with testosterone replacement.

• Testosterone gel – this is usually applied on a daily basis, massaged into the skin such as lower abdomen, arms or legs. Daily administration means the patient can control the amount and achieve a more even blood level. This also more closely mimics the natural production of testosterone from the ovaries both before and after the menopause. Disadvantages of testosterone gel include that absorption may be limited and not all patients notice an improvement in symptoms.

Types of gel include:

I. Testogel 16.2mg/g - 1 pump alternate day or daily

II. Testavan 20mg/g - 1 pump alternate day or daily

III. Tostran gel 2% - 1 pump per day

IV. Androfeme cream 1% - 1 measured application per day

• Testosterone implants – these are inserted under local anaesthetic via a small incision in the lower abdominal wall or the buttock. These are usually replaced every six months but in some cases do not need to be replaced so frequently depending upon the rate of symptom recurrence. Whilst testosterone implants are very helpful to relieve symptoms, one of the disadvantages, apart from the cost, is that this route of administration is associated with peaks followed by a slump as the implant wears out. This however does have a place particularly following hysterectomy or when hormone levels or sex drive are very low and response to other forms of testosterone replacement are limited.
• Injections 

Whichever the route or type of testosterone replacement there is always the potential for side effects which would indicate that the levels are too high relative to the amount of testosterone in the circulation. 

These include:

• Facial hair and body hair
• Thinning scalp hair
• Facial spots
• Potentially cause an adverse effect on cholesterol

In standard doses however these should not occur as the ovaries already produce androgens although at much lower levels than males. Levels of testosterone achieved with gel tend to be lower than with the first two months of implants as the delivery rate is steadier.

Please note that with the use of gel, there may be small residue left on the surface of the skin after the testosterone is absorbed into the circulation. This, in some cases, particularly if applied to the arms, can cause noticeable dark hair growth. This does not mean that the blood levels are necessarily high – simply that a residue has been left on the surface encouraging the hair follicles to grow. Ways to avoid this include varying the site of application and/or washing the gel residue off 2-3 hours after application when the majority of the testosterone has already absorbed.