OBGYN.net: The Universe of Women's Health

After menopause, there are several situations where androgens might play a role.

• First, there are a group of women who ovaries have been surgically removed and who do not "feel right" on estrogen replacement therapy alone. They report lack of energy, lack of sexual interest--just "not being right". The addition of very small amounts of testosterone to their therapy can often make them feel a lot better. The clinical trick is to keep the amount small enough so that the male-directed side effects--weight gain, excessive hair, acne--are kept within an acceptable level.  One way of doing this is to create a daily "foundation" of estrogen by continuous use of estrogen patches and pills and than allowing the woman to "play with" her testosterone dose by taking Estratest HS or Estratest (see below) anywhere from 2-7 times a week.  If she takes too much, she will develop acne, increased facial and abdominal hair growth or even slight loss of hair on the sides of her forehead.  So she can adjust the dose until she feels well and still has no side effects realizing that her estrogen dosage is being held relatively constant.
• Second, if the ovaries remain in place after menopause, the high levels of FSH, which are trying to force the ovary to produce estrogen, may make the ovary produce excessive androgen. This can lead to benign tumors forming in the ovary. This may also explain why some elderly women develop increased facial hair, a coarsening of features, and a deeper gravelly voice. The administration of estrogen may block the production of androgens and reverse this effect.

The main risks of androgen therapy during menopause are changes in the blood cholesterol patterns and levels which may increase the risk of heart disease. These changes are dose related. Testosterone therapy should be used very cautiously in women with elevated cholesterol or LDL-Cholesterol or in women with a strong history of heart disease or high risk profile for heart disease. In my opinion, daily dosages of methyl- testosterone in women should not exceed 2.5 mg.

Androgens for women are available in the following forms in the United States:

Tablets combined with estrogen:

• Estratest HS® Esterified estrogen 0.625 mg and Methyltestosterone 1.25 mg
• Estratest® Esterified estrogen 1.25 mg and Methyltestosterone 2.5 mg
• Premarin with Methyltestosterone (MT)® Conjugated Estrogens 0.625 mg and Methyltestosterone 5.0 mg
• Premarin with Methyltestosterone (MT)® Conjugated Estrogens 1.25 mg and Methyltestosterone 10.0 mg

Injections --testosterone alone: (usual dose is ½ ml every 3-4 weeks

• Testosterone Cypionate 100 mg/ml
• Testosterone Propionate in Oil 100 mg/ml
• Testosterone Enanthanate 200 mg/ml

Injections --combined with estrogen (usual dose is 1 ml every three-hour weeks)

• Testosterone Cypionate 50 mg and Estradiol Cypionate 2 mg/ml
• Testosterone Enanthanate 90 mg and Estradiol Valerate 4 mg/ml

Testosterone Cream

This can be manufactured by a pharmacist in a 1% or 2% lipophilic gel base. The patient rubs between 0.1cc and 0.2cc once or twice a day on her inner thigh.

Testosterone Pellets

Testosterone pellets 75mg 1-2 every 3-4 months has been experimental for about 15 years. The use of testosterone in this form is not approved by the U.S. Food and Drug Administration. It is relatively simple to compound using pure testosterone which has been available in the United States for many years. However, there are only a few endocrinologists in the United States who have access to them. These pellets are available through our practice. They are placed under the skin through a needle. The pellets offer the advantage of very consistent blood levels.