Dr. John Studd
clinical gynaecologist

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Menopause: Testosterone

At last, doctors (and patients) are recognising the importance of testosterone. It is not of course a male hormone, as it is present in the normal young female in even higher concentration than oestradiol. But men, hopefully, have more testosterone on board than women. There is a female androgen deficiency syndrome (FADS) which occurs with failing ovaries and certainly after bilateral oophorectomy which manifests itself with loss of energy, loss of libido, tiredness, loss of self-confidence and headaches. These women respond very well to testosterone. Although testosterone is available in tablets, IM injections, patches and gels, these are not licensed for women and the only way in this country to deliver testosterone is by an implant. For convenience, it seems sensible to insert an oestradiol pellet at the same time as testosterone. The benefits of oestradiol and testosterone are particularly apparent in patients after hysterectomy and bilateral salpingo-oophorectomy because a) they need replacement of the missing ovarian androgens and b) HRT should be straightforward as there is no bleeding and no need for the cyclical progestogen with its PMS type side-effects. Our own data of 200 such patients shows a continuation rate of 96% at 5 years and 88% at 10 years. This brings us back to the initial statement about continuation rates because women feel better.