Question 26 - HRT - Testosterone
(Posted March 15, 2000)

Dr N

First of all, I would like to thank you for your web site. This is the first one I have read in days that didn't leave me feeling hopeless & depressed. I had my hyster. & ovaries removed 6 months ago. Physically, I'm probably doing okay. I still have decreased energy. One fear of lack of libido (since it was good prior surgery) has been fully realized. I am on Premain. Since increasing the dosage to .9mg., I have only a occas. hot flashes at night (very tolerable). I have to admit, my passion for anything has been bottomed out. I keep thinking I'll just need more time. After reading some of your articles, I wonder if testosterone is what's needed. What about increased hair growth, breast CA, etc. I would realy appreciated any comments from you. Thanks again.

Hi,

A few thoughts to share with you.

A woman who has her ovaries removed suffers a significant reduction in testosterone levels. Testosterone is the hormone most closely associated with libido. It is also involved with energy, confidence and maintaining lean tissue. I think that you know all this.

Unfortunately, the concept of testosterone replacement and its benefit when indicated is poorly appreciated by both physicians and patients. Like many other aspects of hormone replacement is is permeated by fear, which stems from lack of familiarity with hormone use and a lingering perception that somehow hormones are somehow harmful.

If you had testosterone levels until the time you had your ovaries removed and it didn't worry you then, you have to wonder why the concept concerns you now. The problem involved in replacing hormone levels is it may difficult to do so in a physiologic manner. I almost always offered testosterone replacement to women who were without ovaries.Very few had problems with increased hair growth. Most those that did, had experienced this problem prior to therapy. If you gave a woman male doses of testosterone, it is conceivable it would create a substantial problem, but of course the aim of therapy is to approximate the normal female adult levels. Women who do find that they have a problem have a number of strategies to employ. They can simply stop the testosterone. If the problem is not very noticeable and they find that their quality of life is improved, they can ignore it, or take a medication, Aldactone, which blocks the influence of testosterone on the skin. It is usually given in a dose of 50 mg, 4 times a day.

It is also important to know that one of the affects of orally administered estrogen is to increase levels of a substance called Sex
Hormone Binding Globulin, (SHBG), which binds to circulating testosterone, leaving less available testosterone to exert its affect. It appears that many instances, you can render a woman physiologically testosterone deficient simply by giving her oral estrogen. This is the reason why many women on oral contraceptives have a decreased libido.

I am not aware of any increased rates of cancer with testosterone therapy.

Let me know what and how you do.

Dr N