In postmenopausal women, the ovaries produce significant amounts of
androgens for many years after the menopause. Bilateral
oophorectomy markedly reduces circulating
testosterone (T) in both pre- and postmenopausal women. Oral
estrogen therapy in postmenopausal women increases
sex hormone-binding globulin and decreases T bioavailablity. Circulating
androgens decrease with increasing age. The occurrence of an
androgen deficiency syndrome associated with loss of libido and sense of well-being is disputed, but in several randomized controlled trials, transdermal T patches produced a significant improvement in
hypoactive sexual desire disorder in postmenopausal women who had bilateral
oophorectomy and in some women who had a natural menopause. T
therapy is legitimate and is clinically indicated in such women. T
therapy may have other benefits in postmenopausal women including an increase in lean body mass and bone mineral density. T
therapy should become an integral part of
hormone therapy in selected postmenopausal women in the future.