Testosterone is a vital hormone in women, eliciting physiologic effects through androgen receptors in almost all female body tissues, including breast, heart, blood vessels, intestines, lungs, brain, spinal cord, nerves, bladder, uterus, ovaries, endocrine glands, vaginal tissue, skin, bone, joints, and fatty tissue. Men produce higher circulating levels of testosterone than women; however, testosterone is the most abundant active sex hormone in a woman throughout her lifespan [2]. Testosterone has been considered a "male hormone", thus largely ignored as an essential hormone in female physiology. This has been unfortunate since attention has not been given to diminished quality of life and potential health consequences when women begin to experience symptoms related to testosterone decline in mid-life. In a woman's body, production of testosterone peaks in her mid-20s and begins to steadily decline, down to about 50% by age 40. This is when a woman will often present with complaints such as increased abdominal fat, hair loss, fatigue, brain fog, loss of sex drive, reduced orgasm, anxiety, irritability, depression, headaches, and general lack of well-being. Most women attribute these symptoms to a natural diminishment of vitality with aging. But, recognizing these symptoms is signaling something about our bodies, and paying attention to hormone health can improve our health and quality of life as we age.
Testosterone replacement therapy for symptomatic women has the potential to improve mood, libido, orgasm, energy level, and feeling of well-being. In addition, documented health benefits include reduced cardiac risk, reduced breast cancer risk, and improved bone density. Testosterone therapy can be beneficial for symptomatic individuals as early as a decade or more before the onset of the menopause transition [5,6,7,8,9,14].
It is important to note that in both men and women, testosterone can be converted within the body's tissues to estradiol, some of which is not measurable, as the conversion takes place within cells where it immediately binds with its receptor. Interestingly, it has been demonstrated that breast cancer survivors using testosterone pellet therapy, combined with medication that blocks the conversion of testosterone to estradiol, reported relief of menopausal symptoms with testosterone therapy alone [14]. Thus, for some women, testosterone pellet therapy will be all that is required to control symptoms. For others, the addition of estradiol and progesterone will be of benefit. Each woman will be individually evaluated, and appropriate options considered.