Will Taking Testosterone Help My Menopausal Symptoms?

Frederick R. Jelovsek MD

The question of whether or not to take testosterone supplements after menopause is not easily answered; it depends upon many variables. In general, testosterone helps elevate mood, improves concentration, improves feelings of fatigue and increases sexual desire or libido. Sometimes, however, if the dose is too much for a given woman, testosterone can produce increased facial hair and male pattern body hair growth, acne, deepening voice and sometimes worsening of the lipid profile. Much female testosterone use in the past had been with fairly large doses resulting in some of the above side effects and negating the beneficial effects.

In a recent journal supplement, Bachmann GA (ed): Role of androgens in the menopause. Am J Obstet Gynecol 1999; 180:S308-340., some of the articles answer what you can expect from added testosterone supplementation during the menopause.

How does testosterone help menopause symptoms?

Testosterone has an effect both directly and indirectly on many menopausal symptoms. Directly it affects testosterone receptors in the brain and in the skin and hair follicles. Indirectly it is converted to estradiol and thus has estrogen effects such as relieving hot flashes, and improving calcium deposition in the bones. It helps sleep disturbances through its estrogen effect but libido improvement and improved feelings of well-being are probably through its direct effects on the cortex of the brain. Most physicians think that menopausal hot flashes cause sleep disturbances and this sleep deprivation in turn causes fatigue, irritability, poor concentration and impaired memory. Therefore if the estrogen effects of testosterone conversion improve hot flashes, it would follow that all of the sleep deprivation symptoms would improve just as much with testosterone as they would with estrogen alone.

This aspect of testosterone therapy has not yet been clarified as to how much additional improvement there is to symptoms of fatigue, irritability, poor concentration or impaired memory with testosterone plus estrogen versus estrogen alone. Most studies do show an overall lessening of these difficult to quantify symptoms when testosterone is added to estrogen. Actually with regard to hot flashes, it has been shown that the estrogen dose can be lowered if testosterone is added thus confirming an additive estrogen effect of testosterone.

Will taking testosterone make me more aggressive or angry?

No, not unless the dose of testosterone you are given is excessive for your body. The more widely recognized effects of androgens, such as aggressiveness or anger typically occur with excess androgens, not with androgens in normal levels. Blood levels (serum) should be kept at :

• testosterone 1.4-1.6 nmol/L (40-50 ng/dL) and
• DHEA -S -- 6-8umol/L (200-300 ug/dL)

or less if there are any symptoms of androgen excess, such as acne, increased hair growth, voice deepening, and temporal balding.

Can testosterone help my decreased sex drive?

Menopause itself is associated with decreased sexual desire independent of estrogen therapy. Any symptoms such as vaginal dryness and pain from dryness during intercourse will worsen sexual desire, but even in the absence of those symptoms, women will report less interest in sexual relations and less responsiveness to sexual stimulation. Testosterone improves these symptoms but does not make them totally revert to premenopausal levels. Obviously it makes a difference if there are other non-hormonal factors that are playing a role in decreasing sexual desire. See our article on Decreased Sexual Desire - Its Many Causes

I am having my ovaries removed when I have my hysterectomy. Do I need testosterone along with estrogen for replacement?

Probably yes. Most studies show the biggest decrease in a woman's natural testosterone level at the time of a surgical menopause rather than the very gradual decline of testosterone during the years around a natural, spontaneous menopause. Testosterone levels can drop from 20-80 ng/dL to approximately 5.0 ng/dL within 24-48 hours of ovarian removal as compared with several years for natural menopause. Unfortunately, most physicians are not prescribing testosterone replacement at the time of premenopausal ovary removal.

Will testosterone help prevent osteoporosis or cause it?

Testosterone prevents osteoporosis as well as estrogens do and perhaps even better. All studies show that testosterone added to estrogens increases bone mineral density more than does the same dose of estrogen alone. Some of the studies suggest testosterone may be slightly better than estrogens at adding bone density but the data are not clearly superior. In either case if testosterone is added to estrogen for hormone replacement therapy in the menopause, even if the estrogen dose is lessened to compensate for the added testosterone, the prevention of osteoporosis will continue as if at the higher estrogen level.

How can I prevent the undesirable side effects of testosterone therapy?

The best way to prevent undesirable testosterone side effects is for you to start out on a low dose of testosterone supplementation, for example 2.5 mg of methyl testosterone if taken by mouth. Additionally, ask your doctor to measure your blood levels of testosterone about 12 hours after a dose and to try to keep your serum total testosterone level in the range of 40-50 ng/ml.

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