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A Woman's Guide to Testosterone
Your biology teacher may have called testosterone the male sex hormone, but women produce this substance, too. Testosterone, manufactured by the ovaries and adrenal glands, fuels a woman's sex drive. That's why doctors often prescribe testosterone supplements—along with hormone- replacement therapy (HRT)—for postmenopausal women who complain of flagging libidos. But it isn't clear whether most postmenopausal women need testosterone supplementation or can benefit from it. I think it's a myth that testosterone declines with age in all menopausal women, says Peter R. Casson, M.D., assistant professor in the department of obstetrics and gynecology in the division of reproductive endocrinology and infertility at Baylor College of Medicine in Houston, who is studying testosterone-replacement therapy for women. He has found little evidence that a woman produces significantly less testosterone after natural menopause. And there's little evidence that testosterone supplements will enhance her sex drive or offer other benefits, he says. If a woman's sex drive is waning after menopause, it could be for any number of reasons, including assorted psychological ones, he notes. On the other hand, there is plenty of evidence that a woman who has had her uterus and her ovaries removed—and gone through the surgical menopause that follows—will see a steep decline in testosterone production. Since the ovaries produce testosterone, levels plummet after the surgery. Some studies do show that, in these circumstances, testosterone supplements help improve sex drive and may alleviate some menopausal symptoms.
But there's still a problem. These studies have looked at the effects of very high doses of testosterone, far higher than a woman would naturally produce, says Dr. Casson. At these levels, testosterone supplements may wreak havoc with a woman's cholesterol levels, causing growth of facial hair, acne, and other unhappy side effects. The testosterone pills usually prescribed for women may also have the potential to cause liver dysfunction, he says. A number of research centers, including Dr. Casson's, are now studying the risks and benefits of a low-dose testosterone patch for women who have had their uteruses and ovaries removed. One of the benefits of the patch is that it delivers testosterone in a fashion that doesn't affect the liver. What to do until the results are in? If you have had both your uterus and ovaries removed and can trace a dip in libido to surgery, Dr. Casson suggests that you wait before you even consider trying testosterone. And he has another suggestion. The drop in estrogen production following surgical menopause can cause vaginal dryness, which can also interfere with sex drive. Since hormone-replacement therapy can alleviate the dryness and may help boost libido, consider HRT before you consider testosterone, Dr. Casson says. If you try HRT, still have a problem, and want to give testosterone a shot, make sure that your doctor prescribes the lowest dose. And ask your doctor to check your cholesterol every six months and your liver function every year, Dr. Casson recommends. Testosterone replacement should be limited to women who have had their ovaries and uteruses removed, who are on good hormone-replacement regimens, and who are still having problems, he says. Even then, they should get a low dose of testosterone. In the Emory study, doctors are screening out men with prostate cancer, BPH, and high risk of :" ":.D., head of the study and associate professor of medicine in the university's geriatrics division. During the study, she and her colleagues regularly tested volunteers' prostate-specific antigen and cholesterol levels.
Testosterone replacement will probably never be as widespread among men as hormone-replacement therapy is among women because many men see no noticeable change in testosterone production until they are well into their seventies, says Dr. Slater. For most men, it's never a problem, agrees Dr. Tenover. Whether testosterone deficiency is a problem for many women isn't yet clear. Since testosterone also drives the female libido, doctors often prescribe testosterone supplements, along with hormone-replacement therapy, for postmenopausal women who complain of flagging sex drive. But the evidence that women produce less testosterone after menopause is shaky, says Peter R. Casson, M.D., assistant professor in the department of obstetrics and gynecology in the division of reproductive endocrinology and infertility at Baylor College of Medicine in Houston, who is studying testosterone supplementation among women. And the long-term benefits of doling out the supplements remain to be seen, he says.
Age Protector's Profile
Adjusting to Hormone -Replacement Therapy
Karen Giblin was in her early forties when she checked into the hospital for a hysterectomy and an ovariectomy. She was prepared for the surgery, but not for what followed. "A few days after the surgery, I was having hot flashes, night sweats, chills, and heart palpitations," recalls Giblin, who lives in Ridgefield, Connecticut.
Giblin's surgery, which involved removing both her uterus and her ovaries, had triggered what's called surgical, or immediate, menopause. Women who go through natural menopause often have hot flashes and night sweats, too, caused by the drop in estrogen production, but they usually don't have the extreme symptoms that come with the abrupt surgical menopause. When it's happening naturally, women see a more gradual decline in estrogen production than those who go through the immediate version. A woman's ovaries produce the lion's share of estrogen, so estrogen levels crash after the kind of surgery that Giblin had.
To alleviate Giblin's symptoms, her doctor prescribed estrogen-replacement therapy (ERT) just before she left the hospital. When she got home, though, Giblin realized that the dose wasn't right. She was still experiencing chills, memory loss, hot flashes—and her heart was racing. She called her doctor, who adjusted the dose.
"It took me about a year to get the proper dose," says Giblin, whose experience led her to start an educational and support program for menopausal women called PRIME PLUS/Red Hot Mamas Menopause Management Education program. It's now offered in more than 35 hospitals and in various HMOs and medical practices nationwide. More than five years after her surgery, Giblin still takes ERT—for the heart and bone protection it affords and to improve her quality of life. Now that the dose is right, she says, she no longer has any noticeable side effects.
Hormone-replacement therapy (HRT) is similar to ERT, but instead of using just estrogen, the formulation includes a synthetic version of the female sex hormone progesterone. But HRT may also require some adjustment, Giblin says. The synthetic progesterone leaves some women feeling queasy and bloated and can trigger monthly vaginal bleeding. But changes in dosage and formulation can ease and even eliminate these side effects, she says.
Your physician should be able to tailor the ERT or HRT to your needs and how you're feeling, she says. You should definitely talk to your doctor if you're having side effects.