Healthnotes Newswire —Women who experience impaired sexual function following surgical menopause (removal of the uterus and ovaries, also called a total hysterectomy) have a new treatment option, according to a study performed at the Massachusetts General Hospital and published in today’s New England Journal of Medicine.¹ According to that report, small amounts of testosterone administered transdermally (by application to the skin) resulted in improvements in sexual function and psychological well-being.

Although testosterone is generally thought of as a “male” hormone, women manufacture this hormone as well, albeit in smaller quantities than do men. About half of the testosterone produced by women is derived from the ovaries and the other half from the adrenal glands.

In women who experience natural menopause, estrogen levels decline substantially, but the ovaries continue to produce similar amounts of testosterone as they did prior to menopause. Consequently, testosterone deficiency is uncommon among postmenopausal women. However, in women whose ovaries have been surgically removed, blood levels of testosterone decline by approximately 50%. Despite receiving estrogen replacement therapy, many women in whom menopause has been induced surgically suffer from a decline in libido and a decreased overall sense of well-being. Previous studies have suggested that these symptoms may be due to a deficiency of testosterone.^{2 3}

To test that possibility, researchers recruited 75 women (age range 31 to 56 years) who reported that their sex life had been less active and less satisfying since undergoing surgical menopause. The women received three different treatments, each for 12 weeks, in random order and in double-blind fashion: 1) placebo, 2) 150 mcg of testosterone per day, and 3) 300 mcg of testosterone per day. The treatments were applied to the skin in the form of a patch, which delivered the medication through the skin into the bloodstream. The doses of testosterone chosen were equivalent to about 50% and 100%, respectively, of the amount of testosterone produced each day by a premenopausal woman. Prior to and throughout the study, all women received estrogen therapy.

Although the women improved considerably while receiving the placebo, there was a significantly greater improvement in measures of sexual functioning and psychological well-being during the higher-dose testosterone period, compared with the placebo period. In contrast, the lower dose of testosterone was not significantly more effective than the placebo. Four women discontinued treatment because of side effects (two became anxious or agitated, one had a recurrence of a nipple discharge, and one developed a skin reaction at the application site). Otherwise, no significant side effects were seen.

The results of this study demonstrated that many women with surgically induced menopause can benefit from adding a small amount of testosterone to their estrogen replacement therapy regimen. Moreover, previous studies using natural testosterone in men⁴ and a synthetic testosterone derivative in women⁵ indicate that treatment with testosterone may help prevent or even reverse osteoporosis, a common problem in postmenopausal women.

While the new study will be welcome news to millions of women, testosterone therapy is not for everyone. Women who have undergone natural menopause typically produce adequate amounts of testosterone, and taking more could cause side effects, such as increased hair growth, deepening of the voice, aggressiveness, and acne. Moreover, although it was not seen in this study, testosterone therapy has been reported to cause potentially dangerous elevations in the hematocrit (a measure of blood count).⁶ Thus, while testosterone supplementation could improve the quality of life of many women, it should be used cautiously and be carefully monitored by a doctor.