Starting treatment for menopause: Part 1 - The importance of testosterone, a human hormone

Testosterone is often referred to as a male hormone and that has always puzzled me. Since I started researching ovarian function it has always been quite clear to me that testosterone is a human hormone. It is produced by the gonads (ovary and testis) of women and men. After the gonads produce testosterone a small portion is converted to estradiol (the main estrogen of the ovary and the testis) and the rest is available for the body to use. Testosterone is as important to a woman's body as a man's. It's as important because it provides the very same health benefits such as maintaining clear thinking and strong bones, helping to fall and stay asleep, improving muscle strength and tone, maintaining sexual response and function, and preventing breast cancer. In fact, the ovaries produce over 3 times more testosterone than estradiol.

The loss of testosterone from ovarian failure can be quite devastating to a woman's health. The reason is clear. Testosterone is produced in abundance by the ovaries and that production ends when the ovaries fail. Failing to replace that testosterone, along with not replacing the other hormones produced by the ovaries, means lost health. Because of this, it has always puzzled me that testosterone is typically not included when considering hormone replacement therapy for ovarian failure.

At its core, replacement therapy should be about treating the illness not just the symptoms. When you seek treatment for hypogonadism be sure to include testosterone in your prescription. Typical starting dosage is from 2-4 mg compounded testosterone cream applied nightly. A testosterone patch is not yet available in the United States but it is available in Europe and can be purchased online. I use a testosterone patch and am very happy with it and it is covered by my insurance.

Remember, treatment for hypogonadism means replacing all of the ovarian hormones (estradiol, testosterone, progesterone and others), not just testosterone. Next time I'll talk about progesterone. Below are references you can print out and take to your doctor on why testosterone should be included.

The conclusions of these trials in which testosterone was added to ovarian replacement regimens are very similar.

1) A physiologic role for testosterone in limiting estrogenic stimulation of the breast
Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA, 2003


Objective: The normal ovary produces abundant testosterone in addition to estradiol (E2) and progesterone, but usually only the latter two hormones are "replaced" in the treatment of ovarian failure and menopause. Some clinical and genetic evidence suggests, however, that endogenous androgens normally inhibit estrogen-induced mammary epithelial proliferation (MEP) and thereby may protect against breast cancer.

Conclusion: These findings suggest that treatment with a balanced formulation including all ovarian hormones may prevent or reduce estrogenic cancer risk in the treatment of girls and women with ovarian failure.


2) Breast cancer incidence in postmenopausal women using testosterone in addition to usual hormone therapy Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA, 2004


Objective: There is now convincing evidence that usual hormone therapy for ovarian failure increases the risk for breast cancer. We have previously shown that ovarian androgens normally protect mammary epithelial cells from excessive estrogenic stimulation, and therefore we hypothesized that the addition of testosterone to usual hormone therapy might protect women from breast cancer

Conclusion: These observations suggest that the addition of testosterone to conventional hormone therapy for postmenopausal women does not increase and may indeed reduce the hormone therapy-associated breast cancer risk-thereby returning the incidence to the normal rates observed in the general, untreated population.