Benefits of Testosterone Therapy in Women

Women’s ovaries produce testosterone alongside estrogen, though they do so in much smaller quantities.

Sometimes, women can have androgen deficiency, meaning that they are low in androgens such as testosterone. This can happen after menopause. Androgen deficiency can impact things such as sexual function, mood, and quality of life¹. Some women may turn to testosterone therapy to assist with related symptoms. Though testosterone can help with some of these conditions, evidence is mixed with others. Advantages of testosterone therapy may include:

• Bone strength
• Protein synthesis
• Prevention of heart disease
• Brain function
• Libido/sexual function
• Red blood cell production
• Breast cancer protection

This article will discuss the mechanisms underlying these potential benefits and the data supporting them.

Bone strength

 As we age, our bone mass progressively decreases due to loss of calcium and other minerals. This is particularly prevalent in women after undergoing menopause. In fact, women may lose as much of 20 percent of their bone density within five to seven years after menopause. Osteopenia, a condition characterized by low bone density, can eventually progress to osteoporosis².

Research suggests that testosterone levels can influence the strength of your bones. One study evaluated the effect of testosterone on bone density and strength in older men. Results indicated that men treated with testosterone had increased bone density and strength in their spine³. Similar results were seen in female-to-male transgender individuals taking testosterone therapy⁴.

Protein synthesis

Testosterone can also have beneficial effects in increasing the production of protein in muscles. One trial, for example, showed that testosterone therapy increased muscle protein synthesis by an average of 27 percent in all nine participants⁵. Another study analyzed males with a muscle wasting condition and concluded that testosterone increased muscle protein synthesis in all six patients⁶.

Prevention of heart disease

As we age, testosterone levels in our blood decrease. Evidence suggests that low testosterone levels correlate with an increased risk of heart disease and cardiovascular mortality, particularly in men^7,8. However, no link between testosterone concentrations and cardiovascular disease has been established in women⁸.

Brain function

 As testosterone levels decline in aging, so does cognition. However, the correlation between cognitive function and testosterone is unclear. Evidence does show that those with Alzheimer’s disease and mild cognitive impairment tend to have lower levels of testosterone. Thus, some postulate that testosterone could have beneficial effects on brain function. One analysis reviewed current literature to assess the association. The study concluded that low testosterone levels could impact cognition. Additionally, supplementing testosterone could positively impact cognitive function⁹.

Libido/sexual function

Increased age is linked to a decrease in libido. In women specifically, androstenedione (A4) and dehydroepiandrosterone (DHEA), are two precursors to testosterone and estrogen. Ovarian production of A4 and DHEA decreases after menopause, potentially leading to a reduction in testosterone. Likewise, some hypothesize that low testosterone in women influences libido.

Some evidence suggests that administering transdermal testosterone to women with decreased libido post-menopause provides some benefit. One study evaluated 549 healthy women who were post-menopause. Participants received transdermal testosterone and oral estrogen. Results indicated a statistically significant increase in frequency of satisfactory sexual experiences for women taking testosterone compared to women taking placebo. Additionally, there was an increase in desire and response parameters taken via a questionnaire.

The mechanisms underlying this phenomenon are unknown. For example, research shows that testosterone and testosterone metabolite levels in the blood are not associated with a woman’s sexual function. Additionally, the safety of systemic testosterone therapy in the long-term is not well-established¹⁰.

Red blood cell production

Testosterone can affect the blood in several ways. In fact, one of the common side effects of testosterone therapy is erythrocytosis. Erythrocytosis is characterized by an increase in red blood cell mass. Additionally, testosterone can also increase hemoglobin and hematocrit in a dose-dependent manner.

One study aimed to characterize the body’s hematological response to testosterone administration. Male participants received either testosterone gel or placebo for a duration of six months. Seven to 10 percent increases in hemoglobin and hematocrit correlated with increased erythropoietin (EPO) and decreased ferritin levels at one and three months. The study concluded that testosterone likely modulates hematologic parameters via stimulating EPO and increasing iron utilization. In turn, this activated red blood cell production¹¹.

Breast cancer protection

Some evidence exists that testosterone may play a role in both the development and prevention of breast cancer. One observational study analyzed 508 women post-menopause who were receiving both typical hormone therapy and testosterone. Researchers assessed their breast cancer status at baseline via mammography and then biannually after testosterone initiation. In total, seven women treated with testosterone developed breast cancer. The rate of breast cancer was 293 per 100,000 woman-years for those treated with testosterone. Comparatively, another study indicated an incidence of 380 per 100,000 woman-years in women treated with estrogen and progestin alone. Likewise, the results of this study indicate testosterone therapy may reduce hormone therapy-related breast cancer risk¹².

For those not on hormones, however, the benefits are unclear. One study, for example, evaluated the association between hormone levels and breast cancer in pre-menopausal women. Findings indicated that those with higher levels of testosterone had an increased risk of breast cancer¹³.

Conclusion

It is no secret that testosterone levels play a key role in several bodily processes. With men in particular, testosterone is a big hormone of interest. Testosterone can be important to a woman’s health and wellness too, especially when one is androgen deficient. In these instances, testosterone therapy has demonstrated some benefits across several symptoms and conditions. However, the supportive evidence can be mixed.

References

1. Testosterone insufficiency in women: Fact or fiction? » Sexual Medicine » BUMC. (n.d.). Retrieved December 16, 2022, from https://www.bumc.bu.edu/sexualmedicine/publications/testosterone-insufficiency-in-women-fact-or-fiction/
2. The national council on aging. (n.d.). Retrieved December 16, 2022, from https://ncoa.org/article/what-is-bone-density-a-practical-guide-for-older-adults
3. Snyder, P. J., Kopperdahl, D. L., Stephens-Shields, A. J., Ellenberg, S. S., Cauley, J. A., Ensrud, K. E., Lewis, C. E., Barrett-Connor, E., Schwartz, A. V., Lee, D. C., Bhasin, S., Cunningham, G. R., Gill, T. M., Matsumoto, A. M., Swerdloff, R. S., Basaria, S., Diem, S. J., Wang, C., Hou, X., … Keaveny, T. M. (2017). Effect of testosterone treatment on volumetric bone density and strength in older men with low testosterone: A controlled clinical trial. JAMA Internal Medicine, 177(4), 471–479. https://doi.org/10.1001/jamainternmed.2016.9539
4. Turner, A., Chen, T. C., Barber, T. W., Malabanan, A. O., Holick, M. F., & Tangpricha, V. (2004). Testosterone increases bone mineral density in female-to-male transsexuals: A case series of 15 subjects. Clinical Endocrinology, 61(5), 560–566. https://doi.org/10.1111/j.1365-2265.2004.02125.x
5. Griggs, R. C., Kingston, W., Jozefowicz, R. F., Herr, B. E., Forbes, G., & Halliday, D. (1989). Effect of testosterone on muscle mass and muscle protein synthesis. Journal of Applied Physiology (Bethesda, Md.: 1985), 66(1), 498–503. https://doi.org/10.1152/jappl.1989.66.1.498
6. Griggs, R. C., Halliday, D., Kingston, W., & Moxley, R. T. (1986). Effect of testosterone on muscle protein synthesis in myotonic dystrophy. Annals of Neurology, 20(5), 590–596. https://doi.org/10.1002/ana.410200506
7. Testosterone therapy fails to improve artery health in older men. (n.d.). Www.Heart.Org. Retrieved December 16, 2022, from https://www.heart.org/en/news/2021/02/22/testosterone-therapy-fails-to-improve-artery-health-in-older-men
8. M Webb, C., & Collins, P. (2017). Role of testosterone in the treatment of cardiovascular disease. European Cardiology Review, 12(2), 83–87. https://doi.org/10.15420/ecr.2017:21:19
9. Beauchet, O. (2006). Testosterone and cognitive function: Current clinical evidence of a relationship. European Journal of Endocrinology, 155(6), 773–781. https://doi.org/10.1530/eje.1.02306
10. Basson, R. (2010). Testosterone therapy for reduced libido in women. Therapeutic Advances in Endocrinology and Metabolism, 1(4), 155–164. https://doi.org/10.1177/2042018810379588
11. Bachman, E., Travison, T. G., Basaria, S., Davda, M. N., Guo, W., Li, M., Connor Westfall, J., Bae, H., Gordeuk, V., & Bhasin, S. (2014). Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: Evidence for a new erythropoietin/hemoglobin set point. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 69(6), 725–735. https://doi.org/10.1093/gerona/glt154
12. Dimitrakakis, C., Jones, R. A., Liu, A., & Bondy, C. A. (2004). Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy. Menopause (New York, N.Y.), 11(5), 531–535. https://doi.org/10.1097/01.gme.0000119983.48235.d3
13. Endogenous Hormones and Breast Cancer Collaborative Group, Key, T. J., Appleby, P. N., Reeves, G. K., Travis, R. C., Alberg, A. J., Barricarte, A., Berrino, F., Krogh, V., Sieri, S., Brinton, L. A., Dorgan, J. F., Dossus, L., Dowsett, M., Eliassen, A. H., Fortner, R. T., Hankinson, S. E., Helzlsouer, K. J., Hoff man-Bolton, J., … Vineis, P. (2013). Sex hormones and risk of breast cancer in premenopausal women: A collaborative reanalysis of individual participant data from seven prospective studies. The Lancet. Oncology, 14(10), 1009–1019. https://doi.org/10.1016/S1470-2045(13)70301-2

Author

David J. Bauder, PA-C David Bauder, PA-C, is a certified physician assistant and the assistant medical director at Weight Loss and Vitality in Manassas and Alexandria, Virginia, Washington, DC; and Gaithersburg, MD. He enjoys helping patients optimize their physical and mental health to improve their overall well-being. He earned his physician assistant degree from the University of Texas Health Science Center at San Antonio. Afterward, he gained admission into the reputable graduate program for physician assistant studies at the University of Nebraska Health Science Center in Omaha. David has over 26 years of experience working as a physician assistant. He’s practiced in podiatry, family medicine, emergency medicine, general surgery, urgent care, and functional medicine.