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| Androgen Therapy in Women
E-Newsletter No. 53Considerations related to androgen therapy in women include preparations, risks, and monitoring. In terms of preparations, testosterone replacement therapy is available in oral, buccal, transdermal, and injectable forms. Methyltestosterone, the most commonly used oral preparation, is usually given combined with esterified estrogen. The product is FDA approved only for use in vasomotor symptoms associated with menopause, but it has been used offlabel to treat decreased libido in postmenopausal women.
Although the liver metabolizes a large amount of methyltestosterone, a much lower amount reaches the bloodstream. Testosterone undeconate, by contrast, is absorbed via the intestinal lymphatic system, bypassing the initial liver metabolism. This preparation is not available in the United States but has been tested elsewhere. Preliminary data on its use in women showed increased sexual desire and sexual activity. Another means of androgen treatment is through the use of oral dehydroepiandrosterone (DHEA) made by compounding pharmacies. Its use must be closely monitored as there is a variable increase in testosterone levels after ingestion of DHEA .
Buccal preparations of testosterone have been tested experimentally, but none are available from a pharmaceutical company. They are, however, prepared by compounding pharmacies. A key factor with this delivery system is that dosages and absorption vary.
Several transdermal preparations are undergoing trials. Compounding pharmacies also provide creams and gels, but as with the buccal preparations the levels of testosterone in the circulation may be very high or very low.
Injectable preparations include testosterone enanthate, testosterone cypionate, mixed testosterone esters, and nandrolone decanoate. Given intramuscularly, testosterone enanthate and cypionate last from one to three weeks. Considerable fluctuation in testosterone concentration is possible, causing some patients to experience emotional lability. Mixed testosterone esters act similarly. There are no data on use of nandrolone decanoate to treat interest/ sexual desire disorder.
Adverse effects in women occur mainly among those abusing androgens for bodybuilding or weightlifting purposes. Acne and hirsutism are the primary androgenic side effects. Acne is seen more often with high-dose methyltestosterone than other preparations. Virilization is rarely seen with physiologic doses.
1. Miller et al. J Clin Endocrinol Metab. 2004;89;525-33.
2. Bachmann et al. Fertil Steril. 2002;77:660-5..
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