From the Research
For a 39-year-old female on an estrogen vaginal ring with low testosterone levels, I strongly recommend considering testosterone supplementation if she's experiencing symptoms like decreased libido, fatigue, or mood changes, as it may improve her quality of life and alleviate these symptoms. The decision to start testosterone therapy should be based on the patient's symptoms and laboratory values, taking into account the potential benefits and risks.
- Testosterone therapy options include compounded creams (typically 1-2% applied daily to the inner thigh or labia), patches (300 mcg/day), or pellets (implanted subcutaneously every 3-4 months) 1.
- Before starting treatment, baseline testosterone levels should be measured, and regular monitoring every 3-6 months is important to ensure levels remain within the female physiologic range.
- Side effects may include acne, hair growth, and voice deepening if levels become too high. The estrogen vaginal ring can continue alongside testosterone therapy as they serve different purposes - the ring primarily addresses local vaginal symptoms while testosterone addresses systemic symptoms.
- Low testosterone in women can contribute to sexual dysfunction, decreased muscle mass, and reduced bone density, so supplementation may improve quality of life when levels are deficient, as supported by a recent meta-analysis published in The Lancet Diabetes & Endocrinology 1.
- Treatment should be individualized based on symptom severity and laboratory values, and patients should be closely monitored for potential side effects and changes in their condition.
- A study published in the Journal of the International Menopause Society found that the addition of low-dose testosterone gel to daily estrogen may improve sexual function in postmenopausal women, although further evaluation and safety data are needed 2.