If testosterone is to be used therapeutically, it must be borne in mind that oral oestrogens may elevate sex hormone binding globulin (SHBG) levels substantially, and hence lower free testosterone. 

It is recommended that if a patient with premature ovarian failure (POF) being treated with oral oestrogen appears to have androgen deficiency, it is prudent to change her to parenteral oestrogen (eg. transdermal or transnasal) and reassess her symptoms after about eight to ten weeks. 

Testosterone levels should be reassessed at this time before considering the implementation of testosterone treatment.

Testosterone therapies 

There are no TGA-approved testosterone preparations for use in women currently available in Australia or New Zealand and initiation of testosterone treatment is  best undertaken by a medical practitioner familiar with this form of therapy. Testosterone may be administered via testosterone implants or a testosterone containing cream.

For women who have also had a hysterectomy, combined implants of oestradiol and testosterone are a very satisfactory method of hormone replacement, requiring repetition every four to six months, but always preceded by measurement of circulating oestradiol and testosterone concentrations. 

If testosterone cream is used, it is customary to prescribe a 1% testosterone preparation and to recheck circulating total testosterone concentrations after the initial three to four weeks of therapy.  Free testosterone can then be calculated on the assumption that significant change in SHBG is unlikely in this time interval. 

The aim of treatment is to restore calculated free testosterone levels to the normal range and to ensure that the upper limit of normal is not exceeded for significant periods of time. 

Side effects of testosterone therapy

When testosterone therapy is monitored carefully and is adjusted to maintain levels in the physiological range, adverse side effects are uncommon. However, testosterone therapy should not be used in professional singers.

Some women complain of a mild increase in facial hair growth or acne, but symptoms of significant masculinisation occur only when supraphysiological testosterone levels are maintained for protracted periods of time.

There is a theoretical risk of masculinisation of a female foetus in the unlikely event that a patient with POF is actually in early pregnancy at the time of therapy.

Content updated August 30, 2006