It is widely recognised that a female androgen deficiency syndrome can be suspected in women with unexplained fatigue associated with decreased or absent libido and decreasing enjoyment of sexual activity. 

A diagnosis should be made only in women who are adequately oestrogenised and is essentially a diagnosis of exclusion. 

The diagnosis is supported by finding circulating concentrations of testosterone, particularly calculated free testosterone (derived from total testosterone and sex hormone binding globulin, SHBG), at or below the lower end of the normal range. 

Calculated free testosterone concentrations in women with androgen deficiency are frequently in the range of 1-6pmol/l. 

From a practical clinical viewpoint then, assessment of the patient presenting with ovarian failure (POF) should include assessment of the possibility that she may have symptoms of androgen deficiency.  These should be suspected if, after adequate oestrogen replacement, she continues to complain of unexplained fatigue and loss of motivation and drive, associated with decreased or absent libido. 

The diagnosis would be supported by finding low calculated free testosterone concentrations, measured in a reliable laboratory.  Many commercial testosterone assays do not have appropriate sensitivity or precision in the low female range.  Thus, “sensitive” testosterone concentrations should be requested. 

The diagnosis should be suspected especially in women who have had bilateral oophorectomies, or who have had chemotherapeutic or irradiation ablation of ovarian function.  However, the diagnosis should be considered in any patient with POF. 

If other causes of these rather non-specific symptoms are excluded, and if the woman’s relationship is secure and content, then consideration can be given to androgen supplementation.  A number of clinical trials, the majority in postmenopausal women, have documented the benefits of testosterone therapy in women with hypoactive sexual desire disorder, which is often a manifestation of female androgen deficiency.

Content updated August 30, 2006