Testosterone: The Forgotten Female Hormone

The purpose of this article is to review the current and past use of testosterone as a replacement hormone for women in peri- and early postmenopause. Healthcare providers are often not educated about testosterone as a sex hormone with profound effects on the female body. Yet, clinicians who treat women in the 4th and 5th decades of life should be familiar with the function of testosterone, clinical symptoms associated with declining levels, women’s perceptions about peri- and postmenopause as well as side effects of testosterone, and the implications of its use as a replacement hormone on other body systems. A comprehensive literature review was conducted using PubMed, the MeSH database, and Google Scholar, and over fifty articles were identified to substantiate the purpose of this article. The results of this literature review reveal that testosterone has been used in various formulations as a replacement hormone in women for over 80 years. Many observational studies and far fewer randomized controlled trials have been conducted. These studies have produced varied recommendations about the indications for exogenous testosterone replacement in women. There is consensus regarding its use in postmenopausal women who suffer from hypoactive sexual desire disorder, but beyond this diagnosis, controversy remains. Additionally, there is currently no Federal Drug Administration-approved formulation of testosterone for women available in the United States. Therefore, women who seek out and receive treatment are utilizing compounded medication as well as dose-adjusted formulations intended for men. The lack of uniform treatment recommendations and availability of products contrasts significantly with women’s desire for clinicians to know and understand testosterone’s role in peri- and postmenopause. This review underscores the need for clinicians to be cognizant of the breadth of research and subsequent opinions regarding the use of testosterone therapy in women to knowledgeably address preventative, acute, and chronic care needs in peri- and early postmenopause. This review also calls for more randomized controlled trials regarding the use of testosterone as a replacement hormone in women to aid in providing more consensus around its use.