The Other Hormone
Hormones considered to be the foundation of masculinity may be a long overlooked component to treating menopausal symptoms and sexual problems in women.
Androgens, a family of hormones that includes testosterone, are crucial to women’s bone health, sexual function, muscle strength and mood, health experts say. Traditionally used by young women who have had their ovaries removed, they are now seen as a possible remedy for health problems experienced by women as they age.
Even otherwise healthy young women are increasingly taking the hormones, often without a prescription, for depression or to boost their libido.
Doctors and researchers say that, although little is known about the long-term effects of these chemicals, they may be able to improve the physical and mental health of women who are not getting adequate relief from estrogen.
“Most women think of testosterone as being a male hormone and estrogen as being a female hormone,” says Dr. James Simon, a clinical professor at George Washington University in Washington, D.C., and an expert on hormones and sexuality. “The reality is that these are not male or female hormones. Both of the hormones are integral in women. Without them there are symptoms, and if you replace them you can alleviate those symptoms.”
Unlike the better-known estrogen, which the ovaries stop making after menopause, androgen begins to decline subtly around age 30 and is reduced by about half by menopause. This gradual decline of the hormone, researchers say, may have disguised its impact.
Doctors have long prescribed testosterone to women who have had their ovaries removed because the sudden plunge in estrogen and androgen can lead to sexual dysfunction and hot flashes. Testosterone, the androgen of primary importance, is also prescribed for women with uncommon pituitary and adrenal conditions that lower testosterone.
More recently, testosterone has been offered to post-menopausal women who continue to have hot flashes or vaginal dryness even though they take estrogen. One prescription product, a pill combining estrogen and testosterone called Estratest, is available for menopausal women.
But researchers are moving past this limited use of testosterone therapy. A testosterone patch is undergoing clinical trials in women with sexual dysfunction, and scientists are studying whether testosterone can improve women’s bone strength, muscle mass and general sense of well-being.
As many as 40% of women complain of some type of sexual dysfunction, studies have shown. Given this figure, androgen replacement should be given the same kind of attention as estrogen replacement, says Dr. Glenn Braunstein, who is testing Procter & Gamble’s testosterone patch at Cedars-Sinai Medical Center.
“Some women develop significant symptoms of androgen insufficiency: low libido, low quality of life,” he says. “Some symptoms improve with estrogen replacement. Hot flashes are clearly improved by estrogen. But once the estrogen is taken care of, if libido stays low and [a blood test shows] free testosterone is low, giving androgen is probably in order.”
No one knows how many women have low libido caused by androgen insufficiency. But Braunstein says that androgen treatment should, for now, focus on post-menopausal women, including younger women who have had their ovaries removed.
“Pre-menopausal women who complain of low libido is the group I’m most uneasy about,” he says. Desire problems in younger women are more likely to be caused by factors other than testosterone levels, such as fatigue and relationship problems, he says.
Nevertheless, androgen use among women of all ages is becoming more popular, despite an absence of research data. A growing number of doctors are prescribing androgens to pre-menopausal women with sexual dysfunction. Other women take over-the-counter DHEA supplements.
“There is a real interest in this, and a fair amount of androgen is already being used,” Braunstein says. “But I worry about the potential side effects.”
Androgens can cause masculinizing features in some women, including acne, facial hair and lowered voice. They can also lead to liver injury, fluid retention, sleep apnea, aggressive behavior and lowering of HDH (good) cholesterol levels. Over-the-counter androgens have other problems. For example, the actual amount of chemical in DHEA supplements can vary “from negligible to higher than is stated on the label,” says Braunstein.
Widespread use of androgens in women is also premature because there is not yet a reliable diagnostic test to quantify androgen levels.
Nevertheless, researchers say they hope the news that estrogen and progestin replacement therapy slightly raises the risk of heart attacks, strokes and breast cancer does not taint this new avenue of research.
While androgen therapy is usually tied to sexual dysfunction, the hormone could prove beneficial to women in other ways, says Simon, noting that several preliminary studies show the hormone can strengthen bones and muscles and lower body fat.
“Androgen therapy, to me, is also about muscle mass, muscle tone and bone density,” he says. “For women in early menopause, having less fat and more muscle and being in better shape and having more strength is a great thing. There is also a whole cadre of issues around androgens and women that have to do with sense of well-being and cognitive function.”
“Testosterone is a medication that has a lot of promise, and we don’t know a lot about its risk or benefits,” adds Dr. Elizabeth Barrett-Connor, a UC San Diego researcher who has studied whether estrogen and androgen together work better to increase bone mineral density than estrogen alone. Women who become menopausal after their ovaries are removed tend to lose bone mass fast.
But women should not jump on the androgen bandwagon as a substitute for estrogen, she adds.
“We really need longer-term safety and efficacy data for testosterone,” she says.
