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Testosterone replacement for women?

Jan 26, 2012

I am an HIV+ woman in my 40's, in good health with suppressed viral load, high CD4 cell count and all that. Recently, though, I have been experiencing fatigue.

I was reading about various possible causes and noted that low testosterone was among them. (I also saw that testosterone levels can affect things like bone health, which I know is important for woman as we get older). When I asked it my doctor if we could check my level he said that he would not know what to do with the information and there really isn't any guidance regarding tesosterone for women. In other words, no.

I don't get it - based on the information I was finding, it seems like clinicians somewhere out there are looking at this and treating it (with success). What gives?

Response from Mr. Vergel

Great question.

There are many reasons why doctors do not test testosterone blood levels:

1- Most do not know what to do with a "low testosterone" blood level result. There are no FDA approved testosterone products for women yet. Some doctors treat testosterone deficiency in women in an off label manner using low doses of products approves for men (gels: Testim, Androgel, Fortesta, Axiron; injections: Depo Testosterone; pellets: Testopel; compounded gels and pellets)

2- There have been small studies that show that testosterone replacement may help women with fatigue and sexual dysfunction, but there is a lot of controversy around the issue. The FDA has shut down the approval process for 5 products in the past from companies that attempted to get them approved for female sexual dysfunction. There seems to be a lot of difficulty defining that end point in an accurate way.

3- The large and long term study of the use of oral estrogen and progestin (The Women's Health Initiative- WHI) in women was halted in 2002 due to increase in breast cancer risks. Compared to women on placebo, women on combination hormone therapy were also at increased risk of stroke, dangerous blood clots, and heart disease, while their risk of colorectal cancer and hip fractures was lower. Even though this study did not include testosterone and only used oral forms of two hormones, it left fear for any hormonal treatments in women.

3- There is some evidence that transdermal estrogen alone or in combination with testosterone may not present the risks shown in the WHI study. But there are no long term data yet. Some women decide on hormonal therapy since their quality of life is so poor that they are willing to take any long term risks in exchange for better energy levels, mood, sexual function and fewer hot flushes during menopause.

There are specialized pharmacies that focus on women's hormones. One of Womens' International Pharmacy. They send you a great packet of scientific references for your doctor to read. Others are Both can refer you to a physician close to your area that is currently using hormone creams for women.

I wrote a longer article about this issue that will be published in a few weeks at to give more details on hormone research.

You may also want to read this previous answer on testosterone in HIV+ women:

Testosterone in HIV+ Women


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