It is well recognized that some women are relatively androgen deficient. This is particularly relevant for younger women with surgically induced menopause. Androgen deficiency is also seen in women with adrenal hypofunction, hypopituitarism, premature ovarian failure or in those on chronic corticosteroid treatment. Also, levels of DHEA (mild androgen produced by adrenal gland) decline after the age of 20 at the rate of about 10% per each decade.
So called “hypoactive sexual desire disorder (HSDD)” is a relatively common condition. The prevalence of female sexual dysfunction in the USA and Europe is estimated to be between 40 and 45%. It could be, however, associated with other factors (depression, chronic illness, medications, relationship difficulties) rather than hormonal imbalance. Androgen deficiency could be just one aspect of this complex problem.
Doctors usually consider androgen replacement when women complain about a lack of libido and energy in spite of being on HRT. DHEA, which is available in the States over the counter as a “health food supplement” , has been used for female sexual dysfunction with variable results. Since it is made by compounding pharmacies the potency varies from batch to batch. It’s use can result in variable increase in testosterone levels and therefore those on DHEA must be closely monitored.
There have been few trials with relatively small doses of a testosterone patch or pellet. Improvement in general well being, energy and mood, as well as reduction in irritability, nervousness, memory problems and insomnia have been reported in women who took androgens in addition to HRT. The problem is, however, that androgen replacement can worsen metabolic syndrome and induce unwanted hair growth and acne.