Testosterone (T) is an important component of female sexuality, enhancing interest in initiating sexual activity and response to sexual stimulation.
Testosterone is also associated with greater well-being and with reduced anxiety and depression. Clinical and biochemical definitions of T deficiency have not been established; hence, the prevalence of this condition is not known. However, surgically menopausal women are among the populations most likely to experience T deficiency, a syndrome characterized by blunted or diminished motivation; persistent
fatigue; decreased sense of personal well-being; sufficient plasma
estrogen levels; and low circulating bioavailable T (either a low total T/
sex hormone binding globulin (SHBG) ratio or free T in the lower one-third of the female reproductive range); and low libido. Exogenous
estrogen, particularly when administered orally, increases SHBG, which, in turn, reduces free T and
estradiol (E2). After
oophorectomy, levels of T and its precursor,
androstenedione, decline by approximately 50%. T replacement continues to be evaluated as an adjunct to
estrogen replacement therapy, particularly for women with
androgen deficiency symptoms, surgically menopausal women and women with
premature ovarian failure. In the United States, oral
methyltestosterone is the common product currently approved for
androgen replacement in women. The best product specifically designed for women has yet to be determined, as standardized, long-term, randomized, control clinical studies are lacking and product refinement continues.