|May 2007 · Vol. 19, No. 05
Androgens in women:
To replace or not?
Androgen therapy can improve sexual desire and response—here’s how
MD, PhD, MPH
Signs and symptoms of androgen insufficiency include a diminished sense of well-being, unexplained fatigue, decreased sexual desire, and thinning of pubic hair
Estrogen plus methyltestosterone improves sexual desire in women after 12 to 16 weeks
Methyltestosterone can cause liver toxicity, so close follow-up is warranted
Katharine Dexter McCormick and Stanley McCormick Memorial Professor and Chair Emeritus, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, Calif
Dr. Polan is a consultant to Procter & Gamble, serving as Chair of the Feminine Protection Scientific Advisory Board. She is also a Director for Wyeth.
Although women produce only one tenth the amount of androgen that men do, testosterone and related androgen metabolites are as important to women throughout the lifespan as is estrogen. Androgens modulate a feeling of well-being, increase energy, support bone metabolism, and improve sexual function in women.1-3 But too much androgen production, with elevated levels of testosterone and dehydroepiandrosterone (DHEA), can result in hirsutism, acne, and infertility in the setting of polycystic ovary syndrome (PCOS), all of which present clinical problems.
An equally complicated topic is androgen insufficiency in women. Not only is it difficult to diagnose, it is a major clinical issue to decide whether, when, and how to replace androgens in women. In this article, I look at androgen production throughout the female lifespan, particularly the relationship between estrogen and androgen. I also describe the evaluation of androgen insufficiency, which requires understanding of androgen physiology and ovarian function before and after menopause. These issues form the basis of the decision to replace androgen in women.