Testosterone treatment in women : Aspects on sexuality, well-being and metabolism

The expected postmenopausal lifetime of women in the western world is about 30 years. Hormones, such as estrogen and progestogen, may affect the quality of postmenopausal life and have been well studied. Androgens act on numerous tissues in the body, however little is known about their biological function in women and the possible effects of androgen insufficiency on women s health. Oophorectomy reduces by half the levels of testosterone in serum and may be associated with sexual problems and a decrease in psychological well-being. Several studies show positive effects of testosterone treatment on psychosexual function and physical as well as psycho-logical well-being in women. Androgens may also have positive metabolic effects on bone and body composition. The aims of this thesis were to explore the associations between androgens and sexual function and study the effects on sexuality, well-being, lipids, bone and body composition of testosterone undecanoate (TU) when added to estrogen treatment in oophorectomized women. Sexual function, as assessed by the McCoy female sexuality questionnaire, showed positive associations between psychosexual function i.e. arousal, desire, satisfaction and various endogenous androgens. The oral administration of 40 mg TU resulted in a median serum testosterone level of 3.2 nmol/L. The addition of testosterone to estrogen for 6 months significantly improved 10 of 14 items on the McCoy scale and had a better effect on interest in sex, satisfaction with frequency of sexual activity and enjoyment of sex, as compared to estrogen alone. Improvements, as judged by the Psychological General Well-Being (PGWB) questionnaire, were similar with both treatments. The change in the serum markers PICP and IGF-I suggested that combined estrogen/testosterone therapy also had a positive effect on bone, but there was no measurable effect on bone mineral density after 6 months. Lean body mass increased, but no changes were found in BMI or fat distribution. TU affected liver metabolism, as assessed by a 13% reduction in HDL-cholesterol. Only mild virilizing side effects occurred during 6 months. In conclusion, androgens were found to play an important role in women s sexual life. The addition of TU to estrogen treatment in oophorectomized women improved psychosexual function. Both estrogen and testosterone improved women s well-being. TU may offer an oral alternative for androgen treatment in women. However, regular monitoring is recommended during therapy because of considerable individual variations in absorption and androgen levels in serum.