Androgens in Health and Disease.pdf - E Library

Chapter 19/Treating Hypoandrogenism in Women 375
Testosterone and its esters are available as an intramuscular injection. A dose of
50–100 mg may be administered 4–6 weekly. Although the pharmacokinetics have not
been extensively studied in women, it appears to have a more rapid onset of effects, with
women reporting enhanced libido 2–3 d after treatment. There is a high incidence of acne
and virilizing side effects, possibly because of rapid high peak levels after administration,
and, thus, should not be used routinely or long term.
Testosterone undecanoate is an oral preparation that is widely used for treatment of
hypogonadal men. In women, however, pharmacokinetic studies have demonstrated that
even very low doses result in supraphysiological peak levels (105).
A transdermal matrix patch has been developed specifically for use in women. Studies
thus far are encouraging because it appears well tolerated and produces stable levels,
with little variation between individuals. The exact dosing and frequency is still being
determined, but it is designed to deliver 150 or 300 µg/d with twice-weekly application.
Testosterone creams and gels are currently being used in clinical trials.
CONCLUSIONS
Controversy continues to surround the issue of testosterone therapy for women. This
review summarizes most of the pertinent data available, but, clearly, there are vast gaps
that need to be filled.
As more women enjoy longer and healthier lives, the demand to optimize quality of
life will increase. Testosterone therapy is an important quality-of-life issue. No woman
will die from testosterone deficiency, but if the link between testosterone depletion and
depression and well-being is established, in addition to the effects on libido, testosterone
therapy will be a therapy to be considered by all women.
The emphasis must be made that no specific testosterone product is approved for use
in women in most countries; yet, historically, its use has been and continues to be
widespread.
In the near future, specific formulations for women are likely to revolutionize this
aspect of women’s health, but in the interim, all women treated with testosterone should
be reviewed carefully and blood testosterone levels should be monitored regularly.
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