That testosterone supplementation might improve some aspects of cognitive and sexual functions, muscle mass and strength, bone mineral density and sense of well-being is not in question. It is, however, not known whether physiologic testosterone replacement can induce clinically meaningful improvements in health-related outcomes in older women without the limiting, virilizing side effects.
It has been assumed that testosterone dose-response relationships are different in women than in men, and that clinically significant effects on psycho-sexual function, body composition, physical function, bone mineral density and other health-related outcomes can be achieved at testosterone doses and concentrations that are substantially lower than those required to produce similar effects in men. Neither of these assumptions has been tested rigorously.
Furthermore, the premise that the organ systems that are the targets of virilizing side effects, such as the skin, hair, vocal cords, and clitoris, differ in their testosterone sensitivity from muscle and bone remains unsubstantiated. The clinical applications of testosterone in women are critically predicated upon the postulate that by appropriate selection of testosterone dose, clinically beneficial effects can be dissociated from virilizing side effects.
There is enormous public interest and media fascination with the issue of androgen supplementation in women. For instance, in the year 2000, the stories related to this topic appeared in many major US newspapers, the Oprah Winfrey show and other television network programs in the U.S., Australia and Europe. The number of stories appearing in the lay press in the last two years far exceeded the number of randomized clinical trials!
In spite of growing media attention, the issue of androgen supplementation in women has remained controversial in the scientific community. Many uncertainties have contributed to a lack of consensus.