Testosterone is the hormone that affects sexual desire. While widely considered the male" hormone because it is responsible for masculine characteristics like facial hair and a deep voice, it is also present in much smaller amounts in women. Like estrogen, testosterone is produced by ovaries and adrenal glands and declines gradually throughout a woman's life.Testosterone replacement therapy is controversial. Here are answers to some of the most Frequently Asked Questions we receive about testosterone and testosterone replacement therapy.

1. What should my testosterone levels be? How do I interpret the results?

While there are no standardized, agreed upon thresholds for what is "normal" testosterone levels at this point, I do find that women who have total testosterone levels of less than 40 ng/dl and free testosterone of 2.0 or less do have symptoms of low libido and/or response.

If your testosterone is low, you can talk to your doctor about potentially replacing your testosterone. If you feel like your sexual response is low and that is feeding into your lack of interest due to pain, dryness, or lack of response or arousal, or physical release, you should consider seeking evaluation and treatment of sexual arousal disorder.

?2. My doctor says I'm too young to have my levels checked. What can I tell him?

Tell your doctor that there has been evidence that even young women have low testosterone. In my practice I have found it extremely common, for instance, in pre-menopausal women after childbirth. If your doctor is unwilling to check your levels, show him or her my book For Women Only!

3. I'm taking estrogen replacement therapy. Can I have my levels checked? Does estrogen replacement affect testosterone levels?

Yes, you can have your levels checked and yes, estrogen can affect testosterone levels. When you replace estrogen without testosterone, the testosterone becomes bound to the cells, increasing something called steroid hormone binding globulin (SHBG). As less testosterone becomes available for the body to use, your levels of free testosterone decrease. You should definitely be checked, and if your testosterone levels are low think about switching to a combined replacement therapy.

4. I'm on birth control and my doctor says I can't have my levels tested. How long do I need to be off birth control before I can be tested?

You should probably be off the pill at least 3-6 months to give you body a chance to re-adjust.

5. What are the specific side effects of testosterone therapy?

Testosterone replacement therapy is controversial. Given in high doses, testosterone has masculinizing side affects like increased hair growth, deepening of the voice, weight gain and acne. More serious side effects with high doses include:

  • Liver abnormalities, including jaundice
  • Edema due to sodium and water retention
  • Virilization (deepening of voice, acne, growth of clitoris, menstrual irregularities)
  • Changes in lipid levels (HDL and LDL cholesterol, triglycerides)
  • Polycythemia (an increase in the total volume or quantity of red blood cells)
  • Hypercalcemia (increase in blood calcium levels)

6. Are there any drug or health interactions with testosterone replacement that I should be concerned about?

Women who have the following medical conditions should not consider testosterone replacement:

  • Liver or kidney disease
  • Women with a history of cardiac problems such as coronary artery disease or heart attack
  • Women who have a low level of HDL ("good") cholesterol, which testosterone can make even lower
  • Women with known hypersensitivity to testosterone

Testosterone interacts with the following drugs:

  • Anticoagulant medications (e.g. Coumadin, Miradon, Sintrom, Warfilone). Testosterone increases the effects of anticoagulants, which can then result in bleeding problems.
  • Oxyphenbutazone, a non-narcotic analgesic. Testosterone can increases its levels in the blood.
  • Insulin. The metabolic effects of testosterone may decrease insulin requirements.
  • Imipramine, a tricyclic antidepressant. Testosterone increases the activity of imipramine; likewise, imipramine increases the activity of testosterone.

Women with the following health or medication concerns should not use testosterone replacement:

  • Health Indications
  • Liver or kidney problems
  • History of cardiac problems: coronary artery or heart attack
  • Low HDL (good cholesterol)
  • Hypersensitivity to testosterone
  • Drug indications
  • Drug Effect
  • Anticoagulant medications (e.g. Coumadin, Miradon, Sintrom, Warfilone)

Testosterone increases the effects of anticoagulants, which can then result in bleeding problems.

  • Oxyphenbutazone, a non-narcotic analgesic; Testosterone can increases its levels in the blood.
  • Insulin; Testosterone can increases its levels in the blood.
  • Imipramine, a tricyclic antidepressant. Testosterone increases the activity of imipramine; likewise, imipramine increases the activity of testosterone.

7. What kinds of testosterone can I get?

Testosterone is available in the form of pure testosterone, testosterone propionate, and testosterone ethanotate or as synthetic methyltestosterone. Testosterone is available several forms including sublingual (taken by mouth) lozenges, sprays, capsules, patches or creams.

8. How long should it take before I see results with testosterone replacement? If I don't notice any change should I ask for a more potent dose?

Depending on the type, it can take anywhere from a few weeks to a few months. For instance, methyltestosterone will work relatively quickly while DHEA takes much longer (sometimes up to 3 months). Don't think about a larger dose without consulting your doctor and your hormone levels. You do not want your testosterone levels to get too high in order to avoid side effects.

9. I'm a man and my wife is taking testosterone cream, will this cream affect my penis in any way?

Theoretically no, but if you notice any changes or symptoms you should seek medical treatment.

10. What about DHEA? Is it okay to use?

DHEA (dehydroepiandosterone) is an androgenic steroid that has been available as an energy booster in the vitamin section of pharmacies and health food stores for years. It's only in the last year that some doctors have begun to prescribe it for low libido in women. It should be taken with a doctor's supervision. There have not been as many studies on the effectiveness for treating low libido, but a recent study out of France indicated promising results. DHEA is not regulated by the FDA and we rarely prescribe it as a first-line therapy.

11. I had cancer or have a family history of cancer; what can be done for me in terms of testosterone replacement?

The precautions for testosterone are the same as for estrogen because testosterone can be converted to estrogen, depending on what type of testosterone replacement you are using. People with liver failure should also be cautious and avoid any oral preparation.

12. What is the correct dosage and how do I apply it?

Testosterone cream is applied in a small amount to the clitoris and inner labia to help improve sensation. It also helps build up thin, atrophic genital tissue. It is available at compounding pharmacies. The dosage we prefer is 2 percent testosterone in cream form, although it can vary from 1 to 3 percent. It should be applied three times a week at bedtime and half an hour before sex if it doesn't fall on one of those days, in carefully dispensed amounts. Using too much can result in increased genital hair growth or an enlargement of the clitoris.

13. I just had a baby/am trying to conceive and want to try testosterone cream, are there any concerns?

Pregnant women and women planning to conceive should never take testosterone because it can cause the fetus to develop problems with the reproductive and genital organs.

When you nurse, your body releases something called oxytocin (the feel good chemical), which does wonders for mommy-baby bonding, but definitely does not help desire and in fact may repress testosterone. Unfortunately it is important to be extremely cautious while pregnant and breastfeeding. Everything you take into your body passes onto your baby and you do not want him getting any hormones right now! It will be difficult to evaluate where you are physiologically, psychologically, hormonally, etc. until you are finished nursing and your body (and spirit) have some time to recover.