Search tips
Search criteria 


Logo of canfamphysLink to Publisher's site
Can Fam Physician. 1999 September; 45: 2100–2107.
PMCID: PMC2328550

Androgen replacement for women.


OBJECTIVES: To determine whether a postmenopausal syndrome comprising specific changes in sexual desire and response associated with low free testosterone exists. To determine whether this syndrome is ameliorated by testosterone replacement. QUALITY OF EVIDENCE: Literature documenting that replacement of physiological levels of testosterone is beneficial and safe is scant. Only one randomized prospective blinded study examines sexual outcome in detail. MAIN MESSAGE: Testosterone is an important metabolic and sex hormone produced by the ovary throughout life. The variable reduction in ovarian testosterone production coincident with menopause is sometimes associated with a syndrome of specific changes in sexual desire and sexual response. Estrogen deficiency also impairs sexual response, but its replacement will not improve and might exacerbate sexual symptoms from androgen loss. Diagnosis of androgen deficiency is clinical, based on accurate assessment of a woman's sexual status before and after menopause and only confirmed (rather than diagnosed) by a low level of free testosterone. Partial androgen replacement restores much of the sexual response and facilitates sexual desire that is triggered by external cues. Avoiding supraphysiological levels of testosterone lessens risk of masculinization. Avoiding alkylated testosterone lessens hepatic or lipid impairment. CONCLUSION: Further prospective randomized studies of replacement of physiological levels of testosterone in women with androgen deficiency syndrome are needed, using formulations of testosterone available in Canada. The consistency of sexual changes, the associated personal and relationship distress, together with our clinical experience of the gratifying response to physiological replacement, make further studies urgently needed.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.8M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Mushayandebvu T, Castracane VD, Gimpel T, Adel T, Santoro N. Evidence for diminished midcycle ovarian androgen production in older reproductive aged women. Fertil Steril. 1996 Apr;65(4):721–723. [PubMed]
  • Weksler ME. Hormone replacement for men. BMJ. 1996 Apr 6;312(7035):859–860. [PMC free article] [PubMed]
  • Longcope C, Hunter R, Franz C. Steroid secretion by the postmenopausal ovary. Am J Obstet Gynecol. 1980 Nov 1;138(5):564–568. [PubMed]
  • McEwen BS, Davis PG, Parsons B, Pfaff DW. The brain as a target for steroid hormone action. Annu Rev Neurosci. 1979;2:65–112. [PubMed]
  • Bachmann GA, Leiblum SR. Sexuality in sexagenarian women. Maturitas. 1991 Mar;13(1):43–50. [PubMed]
  • Nathorst-Bös J, von Schoultz B, Carlström K. Elective ovarian removal and estrogen replacement therapy--effects on sexual life, psychological well-being and androgen status. J Psychosom Obstet Gynaecol. 1993 Dec;14(4):283–293. [PubMed]
  • Studd J, Chakravarti S, Oram D. The climacteric. Clin Obstet Gynaecol. 1977 Apr;4(1):3–29. [PubMed]
  • Van Goozen SH, Cohen-Kettenis PT, Gooren LJ, Frijda NH, Van de Poll NE. Gender differences in behaviour: activating effects of cross-sex hormones. Psychoneuroendocrinology. 1995;20(4):343–363. [PubMed]
  • Kaplan HS, Owett T. The female androgen deficiency syndrome. J Sex Marital Ther. 1993 Spring;19(1):3–24. [PubMed]
  • WAXENBERG SE, FINKBEINER JA, DRELLICH MG, SUTHERLAND AM. The role of hormones in human behavior. II. Changes in sexual behavior in relation to vaginal smears of breast-cancer patients after oophorectomy and adrenalectomy. Psychosom Med. 1960 Nov-Dec;22:435–442. [PubMed]
  • Sherwin BB, Gelfand MM. The role of androgen in the maintenance of sexual functioning in oophorectomized women. Psychosom Med. 1987 Jul-Aug;49(4):397–409. [PubMed]
  • Sherwin BB, Gelfand MM, Schucher R, Gabor J. Postmenopausal estrogen and androgen replacement and lipoprotein lipid concentrations. Am J Obstet Gynecol. 1987 Feb;156(2):414–419. [PubMed]
  • Urman B, Pride SM, Yuen BH. Elevated serum testosterone, hirsutism, and virilism associated with combined androgen-estrogen hormone replacement therapy. Obstet Gynecol. 1991 Apr;77(4):595–598. [PubMed]
  • Burger H, Hailes J, Nelson J, Menelaus M. Effect of combined implants of oestradiol and testosterone on libido in postmenopausal women. Br Med J (Clin Res Ed) 1987 Apr 11;294(6577):936–937. [PMC free article] [PubMed]
  • Davis SR, McCloud P, Strauss BJ, Burger H. Testosterone enhances estradiol's effects on postmenopausal bone density and sexuality. Maturitas. 1995 Apr;21(3):227–236. [PubMed]
  • Watts NB, Notelovitz M, Timmons MC, Addison WA, Wiita B, Downey LJ. Comparison of oral estrogens and estrogens plus androgen on bone mineral density, menopausal symptoms, and lipid-lipoprotein profiles in surgical menopause. Obstet Gynecol. 1995 Apr;85(4):529–537. [PubMed]
  • Arteaga E, Rojas A, Villaseca P, Bianchi M, Arteaga A, Durán D. In vitro effect of estradiol, progesterone, testosterone, and of combined estradiol/progestins on low density lipoprotein (LDL) oxidation in postmenopausal women. Menopause. 1998 Spring;5(1):16–23. [PubMed]
  • Gooren LJ. A ten-year safety study of the oral androgen testosterone undecanoate. J Androl. 1994 May-Jun;15(3):212–215. [PubMed]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada