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Androgen Supplementation in Older Women: Too Much Hype, Not Enough Data: Part 2

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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. The commercially available assays for total and free testosterone were developed for the measurements of much higher circulating concentrations in men; these assays have generally lacked the sensitivity and precision required to accurately measure the lower levels of testosterone in older women.

There has been a paucity of normative data on testosterone levels in menstruating women, older women and women with chronic illnesses; this has made it difficult to define androgen deficiency in women in precise quantitative terms. The available formulations for androgen administration were developed for the replacement of much higher doses required for the treatment of hypogonadal men. Very little pharmacokinetic data exist on the bioavailability and clearance of androgens delivered from the available formulations in women. Therefore, it is not surprising that many previous clinical studies in women used pharmacological doses of testosterone in relatively unphysiological experimental paradigms.

The objective of physiologic testosterone replacement is to restore serum total and free testosterone concentrations into a range that is mid-to high-normal for healthy, young women. Testosterone regimens that increase serum testosterone levels into the supraphysiological range should be viewed as pharmacologic.

Sexual dysfunction in women, a highly complex, multi-factorial issue, has become synonymous with androgen deficiency in the lay press. Observations that pharmacological doses of testosterone might improve sexual function in subsets of women with sexual dysfunction have been unjustifiably extrapolated to advocate testosterone replacement as a general treatment for sexual dysfunction in older women.

It would be incorrect to assert that testosterone supplementation of older women has no role in clinical practice; on the other hand, the available data do not warrant a general recommendation for testosterone replacement for all post-menopausal women.

Link to article: http://www.goodhormonehealth.com/symptoms/androgen.pdf

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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