for Women

Edward Lichten, M.D.,PC
189 Townsend St 2nd floor
Birmingham, MI 48009 


TESTOSTERONE: The Anti-Aging, Muscle Building,
Sex Drive and Mental Sharpness

Testosterone Replacement for Women
"Although women authors including Gail Sheehy and Susan Rako, M.D. have described this deficient testosterone state in women, almost no one talks about it and almost no one does anything about it," states Dr. Lichten. "When women are placed on hormonal therapy, whether birth control of estrogen replacement, their testosterone levels drop dramatically." As physicians, we must listen to our women patients, ask them questions about their sexuality and day-to-day ability to function, and replace testosterone whenever appropriate.

Background Information:
Testosterone is recognized as the hormone of desire: it makes muscles for boys and turns them into sexually functional men. But testosterone is very important to a woman, too. She produces increased amounts of this hormone in her puberty, because testosterone is the precursor to estrogen. Without testosterone, there would be no "woman."

A woman's testosterone levels are highest in the early twenties. The decrease in sex drive we see thereafter is often due to oral contraceptives which suppress all sex hormone production (testosterone, estrogens and progesterone). The treatment is relatively simple: add back some testosterone.

However, physicians see more effects from testosterone deficiency as a woman approaches and enters menopause. The ovaries produce the majority of testosterone and estrogens. With the cessation of 80% of hormonal production, a peri- menopausal woman suffers from estrogen, progesterone and testosterone deficiency. The replacement of estrogen alone does not correct an absent sex drive, loss of muscle tone and general lack of mental get-up-and-go.

Detecting Insufficient Testosterone Levels:
The laboratory tests for testosterone are not helpful. Some women with very low levels do not have symptoms, while others do. The laboratory tests measuring total and free testosterone are rarely of assistance.

Self-Test [St. Louise ADAM Questionnaire]
IT'S NOT ALWAYS EASY to recognize testosterone deficiency. Although this questionnaire is designed for men, women can take it too..

WOMEN who find the following statements true, are candidates for further testing and possible hormone (including testosterone) replacement!

1 and 2 or any 4 answered as 'yes'


  1. Decrease in sex drive.

  2. Orgasm less strong

  3. Lack of energy

  4. Decrease in strength or endurance

  5. Lost height

  6. Decreased 'enjoyment of life'

  7. Sad and/or grumpy

  8. Deterioration in sports ability

  9. Falling asleep after dinner

  10. Decreased work performance

Treatment Alternatives:

Since in healthy young women, testosterone is secreted all day long with a peak in early morning, the ideal replacement would follow this pattern. There are two common delivery mechanisms for testosterone: oral and parenteral. Parenteral refers to through the skin or injections.
While oral tablets may be easy to use, they are not natural, physiologic or healthy. Oral testosterone may dramatically raise the testosterone level, only to have it drop a few hours later. The major drawback to oral testosterone is the "first pass effect." This means that the oral testosterone is absorbed and sent directly to the liver. In the liver, the testosterone effects many enzyme systems and raise the potential for liver dysfunction and even tumors. Most of the oral testosterone is deactivated by liver cells. Oral testosterone raises 'bad' cholesterol and lowers 'good.' It is banned in all modern countries except Canada and the United States. However, much research and development is going on at this time.

An old treatment is the testosterone buccal tablet. Available since the 1950's, compounding pharmacists can imbed natural (aqueous) testosterone in a losenge that slowly dissolves in the mouth. The idea is to have the hormones absorbed through the lymphatics (under the tongue) and not swallowed. In ideal circumstances, 50% of the testosterone avoids the first-pass liver (negative) effects.

The best delivery system used most often since the 1940's has been intramuscular injections of testosterone. There are five injectable testosterone approved in the United States:

  1. Aqueous Testosterone: very short acting (1-2 days)

  2. Testosterone Cyprionate: short acting (2-4 days)

  3. Testosterone Proprionate: short acting (2-4 days)

  4. Testosterone Enthanate: longer acting {7-10 days)

  5. Deca-Durabolin: longer acting, muscle pain relief (7-10 days)

Physicians usually give 50-100 mcg of testosterone to women by injections monthly. But some women find higher estrogen levels and DHEA 25-50mg do effectively increase sex drive without the need for injections of testosterone.

Some compounding pharmacists will make testosterone gel in 3% solutions for women. This works similarly to the patch, but is applied once daily. More rapid absorption occurs over thin skin (labial) while slower absorption occurs over the abdomen. This is aqueous testosterone-- do not use methyl -testosterone as it has liver toxicity effects.

However, we have come to prefer the testosterone pellets. Studies in the United States, Europe and the Far East show that testosterone pellets can maintain a stable hormonal level for up to 120 days. Although there is individual variation from manufacturer and by patient, this delivery system has been the easiest for women to accept when long term replacement is indicated. Both estradiol pellets and testosterone pellets are inserted at one time. This is the method most often used in our office. Almost all our menopausal women add estradiol pellets to the testosterone pellet for the balanced feeling of well-being and control of the 'estrogenic' menopausal symptoms.

Additional Steps to Be Taken:
If women develop an excessive sex drive, a calming effect is found by taking 160 mg of Saw Palmetto with Pygeum twice daily. This herb will block the conversion of testosterone to dihydrotestosterone (DHT) which affects sex drive and acne. There are no significant side-effects to the Saw Palmetto. . A prescription alternative is marketed as Proscar

Risks of Low Testosterone apply only to men:
Until recently, few physicians recognized the need for testosterone in women. Testosterone is superior in the treatment of osteoporosis and muscle wasting. Many of our patients report an improvement in clarity of thought (and sex drive) with low dose testosterone replacement. We do not find that the pellets of testosterone and estradiol affect the lipid profile as noted for the oral testosterone product.

A new philosophy directs the replacement of testosterone in women. Raising testosterone levels have systemic effects, not only improved sexual performance, but also, decreased stress, stronger muscles and helping a woman to stay focused and keep her get-up-and-go.

1. Susan Rako, M.D. [Testosterone] Hormone of Desire. 1996.
2. Gail Sheehy, Ph.D. Men's Passages. 1998
3. Susan Davis. Testosterone Deficiency in Women. Journal of Reproductive Medicine 2001;46:291-296.
4. James A Simon. Safety of Estrogen/Androgen Regimens. i5. Journal of Reproductive Medicine 2001;46:281-290.
6. Maida Taylor. Psychological Consequences of Surgical Menopause. Journal of Reproductive Medicine 2001;46:317-324.
7. Morris Notelovitz. Effects of Estrogen/Androgen Therapy on Bone Mineral Density Parameters. i>Journal of Reproductive Medicine 2001;46:325-331.
8. Gloria Bachmann. Physiologic Aspects of Natural and Surgical Menopause. i>Journal of Reproductive Medicine 2001;46:307-315.
9. Anita Clayton. Assessment of female Sexual Dysfunction. Primary Psychiatry 2001; Apr: 8(4):36-39.
10. Swagata Mandel et al. Clinical Evaluation of Female Sexual Dysfunction: New Diagnostic and Treatment Strategies. Primary Psychiatry 2001; Apr: 8(4):40-59.
11. Julia Warnock. Hormonal Aspects of Sexual Functin in Women: Advantages with Hormone Replacement Therapy. Primary Psychiatry 2001; Apr: 8(4):60-64.
12. Lawrence Labbate. Sexual Dysfuction and Antidepressants. Primary Psychiatry 2001; Apr: 8(4):65-68.
13. H. George Nurnberg et al. Sildenafil Treatment of Antidepressant-Associated Sexual Dysfunction: A 12-Case Treatment Replication in a Naturalistic Clinical Setting. Primary Psychiatry 2001; Apr: 8(4):69-78.






Revised: January 1, 2007