What are the side effects for women using testosterone cream for loss of libido?

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Women normally have circulating in their blood 3 major sex hormones: oestrogen, testosterone and progesterone. Each of these is produced by the ovaries. Oestrogen is also made throughout the body but particularly in body fat. Testosterone can also be made in other parts of the body from hormones (DHEA and DHEAS) that are produced by the adrenal glands.





At the time of natural menopause or surgical removal of the ovaries oestrogen and progesterone levels fall precipitously.





Testosterone and DHEAS levels however fall more gradually with increasing age such that a woman in her forties has on average only half of the testosterone and DHEAS circulating in her bloodstream as does a woman in her twenties. After a woman has her ovaries removed by surgery testosterone levels can fall by up to fifty percent. However testosterone does not change across menopause, although this varies somewhat between women.





Testosterone and other related hormones (DHEA and DHEAS) in the body (also known as androgens) have known physiological roles in women. Firstly, oestrogen is actually made from testosterone and DHEA, and without the ability of our bodies to make testosterone we cannot make oestrogen. Testosterone and DHEA appear to have direct independent effects in different parts of the body, and some women may experience a variety of physical symptoms when their blood levels fall. Such symptoms may include:





impaired sexual interest (loss of libido or sexual desire), and lessened sexual responsiveness








lessened wellbeing, loss of energy.





Testosterone therapy may be beneficial for some women who have had their ovaries surgically removed or in some cases who have significant symptoms in the form of loss of libido, fatigue and diminished wellbeing.





Caution


Testosterone therapy will not be the answer for someone who has a poor partner relationship, depression or poor wellbeing due to other causes.





Measuring Testosterone


All women should have a blood test to measure their testosterone level before starting any testosterone replacement mainly to exclude higher levels of testosterone.





There is no set level of testosterone below which suggests or guides treatment, but it is essential that women with normal or high levels are not misdiagnosed and treated with androgens.





Women should also have thyroid disease and iron deficiency excluded as possible causes of their symptoms by having a blood test for these conditions.





Most methods for measuring testosterone are fairly imprecise and become even more inaccurate when blood levels of testosterone are low. Blood should be taken ideally between 8:00am and 10:00am as testosterone levels vary throughout the day. For women who have regular cycles, blood should not be taken during the menstrual phase as testosterone levels are low at this time in most women and thus the result may be misleading. Thus blood should be drawn at least 8 days after the start of menstruation.





Recent Jean Hailes research has shown no relationship between testosterone levels and loss of libido and sexual dysfunction. Therefore levels cannot be used to diagnose androgen insufficiency, only to ensure levels are not elevated. Levels of testosterone also cannot guide replacement of testosterone.





The factors that do influence libido are discussed by psychologist Dr Amanda Deeks PhD, in her ';10 tips for understanding and improving your libido';.


[More on the 10 tips is available at Libido]





10 tips for understanding and improving your libido


1. What influences your libido? We all have our own individual levels of sexual desire or libido. More...


2. Assess your own libido How would you describe your level of sexual desire? Do you desire sex frequently, sometimes, every now and then or never? A low libido is only a problem if you perceive it to be a problem. More...


3. Why do you have sex? There are many reasons for having sex and lust is only one of these. More...


4. Check your desire switch When we first get together with our partner there is often a lot of sex and a lot of intimacy. You just can鈥檛 keep your hands off each other! At the beginning of a relationship we want to impress and make a greater effort to please our partner. Over time this level of desire might drop away. More...


5. Understand the physical We often jump in to sexual relationships without really understanding or knowing what actually happens to our bodies when we become intimate. More...


6. Accept your libido may be


different to that of a man Just as there are individual influences on our sexual libido there may also be some differences between men and women when it comes to desire. More...


7. Stop comparing We often think that everybody is having more sex than we are, or that young beautiful, thin people have lots of sex. We want to know the average number of times couples have sex so we can compare where we are at. More...


8. Watch out for depression and


anxiety 1 in 5 adult Australians will experience an anxiety or depressive disorder. As you can imagine mood disorders impact negatively on libido. More...


9. It鈥檚 okay not to always feel


desire when you have sex Some women feel that they should desire sex every time they have it. They say they would feel fake if they have sex and they don鈥檛 feel desire. So, if they don鈥檛 feel desire then they don鈥檛 have sex. It鈥檚 okay to have sex even though we don鈥檛 feel desire. More...


10. Seek help if you need to If you have thought about your libido and are worried about something or it is causing you problems then it is important to do something about it. More...


Dr Amanda Deeks PhD, The Jean Hailes Foundation














For those women with persistent low libido in whom lifestyle and relationship issues have been addressed, testosterone therapy may be appropriate. Therapy may improve libido, especially in oophorectomised women.





However with libido and testosterone therapy in women, there are areas that need further research, these include:





defining the clinical features of androgen insufficiency in women








appropriate testing/investigation








appropriate testosterone preparation availability for women








safety data on longer term use.





If Testosterone Therapy is used


Testosterone can be taken as tablets, by injection, as an implanted pellet, as a skin patch, gel or spray.





Currently no form of testosterone therapy is officially approved in Australia by the Therapeutic Goods Administration for women. However for many years testosterone has been in used in public hospital specialist clinics, and in private practices for postmenopausal women with low testosterone levels. Decisions on use need to be made in partnership between women and their doctor.





For many years the most commonly used form of therapy for women has been with a testosterone implant pellet. This is a very small pellet which is implanted in the fat of the front lower abdomen, using a small incision (less than 1cm). The procedure takes approximately ten minutes to perform. The pellet releases testosterone over a period of 3 to 6 months, after which time it needs to be replaced. We most commonly recommend the use of 50 mg of the testosterone implant, although rarely 100 mg is required.





Testosterone tablets (Andriol庐) are available on prescription however they are only available in a dose form developed for men, and much less is known about their action in women or about what is the most suitable and effective dose. The use of testosterone tablets by women can not be recommended.





Testosterone injections can also be used, however these result in very high levels of testosterone as they were developed for use in men, and little is known about the actual release dynamics of the injections in women. Their use cannot be recommended other than for a very short term trial of administration to guide the likelihood that chronic therapy will be effective.





Testosterone skin patches have been developed and are now undergoing research trials which are addressing their safety and efficacy. Similarly studies are underway evaluating the safety and effectiveness of a testosterone gel and a skin spray in women.





A testosterone cream is available in Western Australia that has been approved by Western Australian health authorities for use in women. It is called Androfeme庐. This cream has been used in some short term studies, however there is no long term safety information regarding its use.





Some physicians and pharmacists are promoting the use of testosterone and DHEA (another androgen) in the form of lozenges (also called troches), which are sucked in the mouth or given as creams. These have been labelled as being ';bio-identical'; however they are no more bio-identical than the other forms of testosterone that are available or undergoing research. The lozenges result in extremely high blood levels of testosterone, well above those appropriate for women. There is no research evidence that they are safe or even effective, and their use cannot be recommended.





A recent well-designed trial of two years of DHEAS therapy suggests no benefits on well-being, libido, sexual function, cardiovascular risk factors and other ageing related endpoints. More research is needed. DHEAS is currently banned from importation into Australia and is not approved for use.





Side Effects of Testosterone Treatment


Short-term side effects of testosterone therapy appear uncommon when testosterone is used in appropriately selected women and given in the appropriate dose. However side effects will occur in any woman if the dose of the testosterone is in excess of her needs. Such side effects include masculinisation with acne and excess body hair, scalp hair loss, fluid retention, deepening of the voice, enlargement of the clitoris and adverse effects on blood cholesterol. It is our experience that these side effects are rarely encountered if the appropriate dose of testosterone is administered and blood levels are regularly monitored.





Women with severe acne or severe excess body hair, or with thin scalp hair should not use testosterone. Women with very low levels of SHBG may be at increased risk of side effects of testosterone and therapy should be used very cautiously with careful monitoring. Similarly, testosterone should not be used by women who are pregnant or lactating or who have a suspected cancer. Some studies have shown that high levels of testosterone are more common in women who develop breast cancer, however there is no data to indicate any association between testosterone replacement and breast cancer.





Testosterone levels must be monitored during treatment and blood levels achieved with therapy should be kept within the normal range for women.





The current settings in which testosterone therapy may be beneficial in women include


Early ovarian failure.





Symptoms due to menopause following surgical removal of the ovaries, chemotherapy or radiotherapy.





Symptoms in women with premature spontaneous menopause








Warnings


Any woman using testosterone during child-bearing years must have reliable contraception as testosterone may result in virilization of a female foetus if it is used after conception.








All women using testosterone cream should have a blood test after 3 weeks use and should be reviewed at 6 to 8 weeks by their doctor.








No woman should continue treatment beyond 6 months if a clear benefit has not been achieved.








There is no information regarding the safety of the use of testosterone in women long term.








Testosterone is not currently approved for use in women by the TGA and FDA pending further research.





Useful Resources





Hormones








Until menopause, a woman produces three different natural female hormones.








Hormone Therapy Benefits








Short term use of hormone therapy (HT) may be useful for women experiencing more severe symptoms of menopause.








Hormone Therapy Side Effects








Some women may experience nausea, fluid retention, breast enlargement and discomfort, particularly during the first few months of taking HT.What are the side effects for women using testosterone cream for loss of libido?
Testosterone might make you hairy.What are the side effects for women using testosterone cream for loss of libido?
I'm not a woman but I think it gives you men genitalia.
I'm guessing it can be hair growth, like on face or whatever, but I don't know. Possibly muscle growth?
Due to the increase in testosterone she may grow a 'stache and might begin physically abusing you due to increased aggression.