Testosterone for women
|Generic Name||Brand Name|
|Methyltestosterone and esterified estrogens||Estratest, Estratest H.S.|
Oral estrogen-methyltestosterone, such as Estratest, is sometimes used for moderate to severe menopausal symptoms that have not improved with estrogen alone and for menopausal women to improve sexual desire and response.
Methyltestosterone with estrogen is not approved by the U.S. Food and Drug Administration (FDA) for any medical use.
How It Works
Testosterone is known as a "male" hormone, or androgen. It also is made in small amounts by a woman's adrenal glands and ovaries. A woman's testosterone is highest around age 20 and slowly declines till it is half as high in her 40s.1
- In men, testosterone is linked to male physical traits and sex drive.
- In women, testosterone may be linked to sex drive. But for women, interest in sex is much more complicated than just testosterone levels.
Testosterone therapy raises testosterone levels in the body. But, testosterone without added estrogen is only FDA-approved for use in men. In women, it may improve sex drive, but it can cause male-type physical traits when taken in too high a dose. Many doctors are hopeful that a safe, low-dose testosterone will be available for women in the future.
Methyltestosterone probably does not work in the body and the brain like natural testosterone does. It does not directly raise a woman's testosterone levels, and it cannot be measured in the blood like natural testosterone. But taking methyltestosterone does seem to free up some of the body's natural testosterone. This may be why some women have more sex drive when taking a low dose of methyltestosterone.2
Why It Is Used
Methyltestosterone and testosterone treatment for women have not been well studied and are not approved by the FDA. Studies of testosterone in women have not lasted longer than 6 months. FDA experts want to know more about long-term risks before they approve testosterone for female use.
Methyltestosterone. The company that makes Estratest markets it for moderate to severe menopausal symptoms that have not improved with estrogen alone. This hormone product is sometimes also prescribed to menopausal women for improving sexual desire and response.
Testosterone is an experimental treatment used to raise a woman's sexual interest, arousal, and satisfaction. Women with low androgen levels who might benefit from low-dose testosterone therapy include those who:
- Have had their ovaries removed (oophorectomy). This causes a sudden drop in testosterone, which may decrease sex drive and satisfaction.
- Have a low sex drive that does not seem to be caused by a medicine, nor by relationship or stress-related problems.
- Have an adrenal system problem or an underactive pituitary gland (hypopituitarism).
Do not take testosterone if you:1
- Could become pregnant. Taking testosterone while you are pregnant can cause a female fetus to develop male traits.
- Have or have had breast or uterine cancer.
- Have high cholesterol or heart disease.
- Have liver disease.
How Well It Works
There is not strong enough evidence to support the use of testosterone for improving menopausal symptoms.1
In many women, testosterone may have a direct effect on sex drive and sexual response. Women taking testosterone may have more sexual thoughts, fantasies, activity, and satisfaction.4
There is no solid link between a woman's high testosterone and high sex drive, nor between low sex drive and low testosterone. You can have a low testosterone level in your body and have a normal sex drive or have high testosterone and very little interest in sex.
In women, long-term testosterone side effects have not been studied.1 Experts know that:
- Oral testosterone lowers "good" HDL cholesterol and raises "bad" LDL cholesterol in the blood. High cholesterol is known to increase risks of heart disease and stroke.1 This is why experts want to know more about long-term oral testosterone therapy.
- Testosterone should not be taken during pregnancy because it affects a growing fetus.
Testosterone treatment for longer than 6 months has not been studied. Experts do not yet know whether it raises risks of breast cancer, heart disease, or dangerous blood clots. It may increase these risks, because some testosterone in the body is made into estrogen. Higher-than-normal estrogen in the body is linked to these risks.1
The goal of testosterone treatment is to raise a woman's testosterone level no higher than what is normal for a young woman. All current testosterone products are made for dosing in men. There is not yet a standard dose or blood test for women, so dosing is adjusted based on your symptoms. You are taking a dose that is too high if you have:
- Acne or oily skin.
- Male-pattern hair loss from the scalp.
- Male-pattern hair growth on the face and body.
- Anger and hostility problems.
- Shrinking breast size.
- Hoarseness or a deeper voice. (This is the one side effect that may not go away after you stop testosterone treatment.)
- Irregular menstrual cycles, if you have been menstruating.
- An increase in the size of your clitoris.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Taking testosterone by using a skin patch, gel, or cream does not seem to affect cholesterol levels, but taking it by mouth does. This is because hormones are processed through the liver when taken by mouth, but not when they are taken through the skin.1 But, there are no such FDA-approved testosterone products for women at this time.
Some women go to a compounding pharmacist for "bioidentical" hormone remedies.
- Risks of bioidentical hormones are not known to be any different than risks of hormones made by a pharmaceutical company.5
- Many compounded hormone remedies for menopausal symptoms include testosterone. Talk to your health professional about testosterone risks before using any remedy with testosterone in it.
Many other supplements may interact with testosterone. Be sure to tell your health professional about any nonprescription medicines, supplements, or herbs you are taking.
An overdose of androgens may cause seizures, hepatitis, problems with blood clot formation, or other serious health problems. Taking DHEA and testosterone together may be dangerous. (DHEA is an androgenic dietary supplement that is derived from the wild yam. It is also called prasterone in the United States.)
Testosterone should not be taken during pregnancy because it affects a growing fetus. If you use testosterone and could become pregnant, use highly effective birth control.
- North American Menopause Society (2005). The role of testosterone therapy in postmenopausal women: Position statement of the North American Menopause Society. Menopause, 12(5): 497–511.
- Lobo RA, et al. (2003). Comparative effects of oral esterified estrogens with and without methyltestosterone on endocrine profiles and dimensions of sexual function in postmenopausal women with hypoactive sexual desire. Fertility and Sterility, 79(6): 1341–1352.
- Basaria S, Dobs AS (2004). Safety and adverse effects of androgens: How to counsel patients. Mayo Clinic Proceedings, 79(Suppl): S25–S32.
- Shifren JL (2004). The role of androgens in female sexual dysfunction. Mayo Clinic Proceedings, 79(Suppl): S19–S24.
- North American Menopause Society (2004). Treatment of menopause-associated vasomotor symptoms: Position statement of the North American Menopause Society. Menopause, 11(1): 11–33.
Last Updated: March 11, 2008
Author: Caroline Rea, RN, BS, MS