Introduction

Testosterone is a naturally occurring sex hormone produced in all people. While it is typically found in higher levels in people with testicles, or transgender men undergoing gender-affirming therapy, testosterone also plays important roles in female health when testosterone levels get too low.

In recent years, there has been growing interest in the use of testosterone in women for various medical conditions. This article explores the medical applications of testosterone in women, the considerations surrounding its use, and the potential benefits and risks.

Medical Applications of Testosterone in Women

1. Hormone Replacement Therapy (HRT): One of the most common uses of testosterone in women is as a component of hormone replacement therapy. Women who have reduced testosterone production due to surgery, medication or ovarian failure, can experience hormone deficiencies that may benefit from testosterone supplementation to restore hormonal balance. This can help alleviate symptoms such as hot flashes, mood changes, decreased libido and sexual dysfunction.
2. Hypoactive Sexual Desire Disorder (HSDD): Testosterone has been investigated as a treatment for hypoactive sexual desire disorder, a condition characterised by a persistent lack of interest in sexual activity. Some women with HSDD may experience an improvement in libido when prescribed testosterone therapy.
3. Osteoporosis: Testosterone plays a role in bone health, and its supplementation can help prevent or manage osteoporosis in women. Increased bone density and reduced fracture risk are potential benefits.
4. Muscle Mass and Strength: In certain medical conditions, such as muscle-wasting diseases or after major surgeries, testosterone may be prescribed to help women regain muscle mass and strength.
5. Androgenisation: People who are assigned female at birth may choose to balance their hormones to a more androgynous profile by adding testosterone to their natural estrogen production.

Considerations for the Use of Testosterone in Women

1. Dosing and Monitoring: Testosterone therapy in women requires careful dosing and monitoring. It should be administered under supervision and be tailored to individual needs, adjusting dosage and frequency as necessary.
2. Side Effects: While testosterone therapy can have positive effects, it may also lead to side effects associated with masculinisation. These effects can vary widely among individuals.
3. Risks and Long-Term Effects: The long-term effects of testosterone therapy in women are not yet fully understood.
4. Monitoring Hormone Levels: Regular monitoring of hormone levels, including testosterone and estrogen, is crucial during therapy to ensure hormonal balance and address any adverse effects promptly.
5. Individualised Approach: Testosterone therapy should be individualised, taking into account a woman’s overall health, medical history, and specific treatment goals. Treatment plans should be made with fully informed consent.
6. Erectile Function: Although testosterone can support libido and sex drive, it has no direct effect on erectile function, for an immediate response as required, medication such as PDE5 inhibitors eg Viagra, sildenafil, Cialis should be used.

Conclusion

Testosterone therapy in women can have several medical applications, including hormone replacement, addressing sexual health concerns, managing osteoporosis, and supporting muscle recovery. However, its use requires careful consideration, monitoring, and supervision. The benefits and risks must be evaluated on an individual basis to ensure that the potential advantages outweigh any potential adverse effects. Women considering testosterone therapy should engage in open and informed discussions to make well-informed decisions regarding their treatment.