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Testosterone supplementation: For whom and when?
Sexuality, Reproduction & Menopause, 10/08/09

Khera M – Evidence shows that testosterone, added to estrogen therapy (ET), improves sexual function in women and may improve bone health. However, the absence of an FDA–approved agent, off–label use raises questions about patient selection, dosing, and safety. Approval of testosterone–containing preparations has been deferred pending confirmation of long–term safety assessments (2–5 years). Evidence suggests that testosterone supplementation does not increase the risk of breast cancer; it may have a protective effect on breast tissue. A longer time to disease progression and a higher response rate is observed when androgens are added to anti–estrogen therapy. Long–term androgen administration does not have significant, adverse effects on female breast tissue. Nevertheless, testosterone can still be aromatized to estrogen; patients with a history of estrogen–sensitive breast cancer should be discouraged from treatment. No convincing data suggest that testosterone use increases the risk of cardiovascular events in women. Although oral methyltestosterone has been shown to reduce HDL and raise LDL levels in women, this effect is not seen in association with other forms of testosterone. Finally, no evidence indicates that testosterone supplementation increases the risk of endometrial cancer.

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