Abstract

Although testosterone treatment is increasingly prescribed by men, there are still many questions and concerns regarding testosterone (T) and in particular T treatment in women. A literature search was conducted to clarify the origin and scientific basis of many concerns and hypotheses regarding T&T treatment in women.

This article eliminates ten common myths and misconceptions and provides evidence for what is physiologically probable and scientifically obvious: T is the most biologically active female hormone, T is important for women’s physical and mental health, T is not masculinizing, T does not cause hoarseness, T increases scalp hair growth, T is heart protection, T does not affect the liver or increase clotting factors, T stabilizes mood and n ‘does not increase aggression, T protects breasts and T treatment safety in women examined and established.

Dropping myths, misconceptions and unfounded fears of T&T therapy in women will enable clinicians to provide evidence-based recommendations and appropriate therapy.

1. Introduction

Testosterone (T) therapy is increasingly used to treat hormone deficiency symptoms in women before and after menopause. Recently, especially with the advent of the T-patch, more research is being done on the safety and effectiveness of T-therapy, but there are still many misconceptions about T- and treatment with T in women, especially in the United States. This review discusses and provides evidence to dispel some of the most common myths.

The main source of misconceptions about T treatment in women comes from epidemiological studies that suggest high (endogenous) levels of T in certain diseases. These data are misleading to present a pathogenic model of these diseases without sufficient evidence or probabilities to support a causal relationship. False conclusions, which are repeated quite often, especially when supported by unofficial observations, create “myths” that are widely accepted, even without biological or physiological justification.

Another source of confusion about the safety of T therapy in men and women is the extrapolation of side effects (eg, changes in mental status, aggressiveness, heart and liver problems, endocrine disorders, risk of abuse) of high doses of oral and injectable drugs. . anabolic. Androgenic steroids for the treatment of T, despite the lack of evidence. In this review, testosterone (T) refers only to bioidentical testosterone (an identical human molecule), and not to synthetic oral androgens or anabolic steroids.

T is licensed in England and Australia and has been used by women for over 60 years. But as of 2013, there is no authorized T product for women in the United States and human / bioidentical T is regulated as a “Schedule 3” drug and is listed as a “Class X” teratogen. .

2. “Top 10” Myths About Testosterone Use In Women

2.1. Myth: testosterone is a “male” hormone

T has also been referred to as a “male hormone” in scientific literature. Men have higher circulating T levels than women; quantitatively, however, T is the most common active sex steroid in women during a woman’s lifetime (Fig. 1) [1]. T is measured in units 10 times higher than estradiol (E2), ie nanograms / dl or micromolar compared to picograms / ml or picomolar for E2. In addition, there are exponentially higher levels of proandrogens: dihydroepiandrosterone sulfate (DHEAS), dihydroepiandrosterone (DHEA) and androstenedione, which provide significant amounts of T-androgen receptors (RA) in both sexes. In fact, the intervals measured for androgen precursors are equal in men and women.

Despite some clear justifications, estrogen is considered a “replacement therapy” hormone in women. But as early as 1937, T was reported to effectively treat symptoms of menopause [2]. Biologically, women and men are genetically similar in that they have functional estrogen receptors (ER) and functional androgen receptors (AR). Interestingly, the AR gene is located on the X chromosome. T, in equilibrium with lower amounts of E2, is equally important for both sexes. In addition, T is the most important substrate for E2 and has a side effect in both sexes via ER.

Ended

Testosterone is the most abundant biologically active hormone in women.

2.2. Myth: The only role of testosterone in women is libido and libido

Despite numerous recent publications, the role of T in sexual function and libido is only a small fraction of the physiological effect of T in women. Functional RA is found in almost all tissues, including the breast, heart, blood vessels, gastrointestinal tract, lungs, brain, spinal cord, peripheral nerves, bladder, uterus, ovaries, endocrine glands, vaginal tissue, skin, bones, bone marrow, synovial membrane, muscles and adipose tissue [3], [4].

Testosterone and proandrogens gradually decrease with age in both sexes. Premenopausal and postmenopausal women and elderly men may experience symptoms of androgen deficiency, including dysphoric mood (anxiety, irritability, depression), poor well-being, physical fatigue, bone loss, muscle loss. , cognitive changes, memory loss, insomnia, hot flashes, rheumatoid disorders, pain, chest pain, urinary tract, incontinence and sexual dysfunction. These symptoms of androgen deficiency are increasingly recognized and treated in women by treatment T [5], [6], [7]. Androgen deficiency symptom rating scales have been developed to standardize symptom severity and measure the effectiveness of treatment. Biologically active functional RAs are localized throughout the body in both sexes: it is unscientific and unlikely to assume that there is no androgen deficiency in women or that treatment with T should not be considered in women.

Ended

Testosterone is important for the physical and mental health and well-being of women.