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Hormone Replacement Therapy (HRT)

Hormone replacement therapy (HRT) is a system of medical treatment for surgically menopausal, perimenopausal and postmenopausal women, based on the assumption that it may prevent discomfort and health problems caused by diminished circulating estrogen, progesterone and testosterone. HRT may be by patches, tablets, creams, troches, IUDs, vaginal rings, gels or, more rarely, by injection.

HRT is seen as either a short-term relief (often one or two years, usually less than five) from menopausal symptoms (hot flashes, irregular menstruation, fat redistribution etc.) or as a longer term treatment to reduce the risk of osteopenia leading to osteoporosis. Younger women with premature ovarian failure or surgical menopause may use hormone replacement therapy for many years, until the age that natural menopause would be expected to occur.

Hormone Replacement Therapy and Female Testosterone

Just as men's bodies manufacture small amounts of oestrogen, women's bodies produce testosterone through the ovaries and adrenal glands. A multitalented hormone, testosterone boosts both low libido and energy, maintains muscle mass, strengthens bone and ensures the nipples and clitoris are sensitive to sexual pleasure.

As women age, their bodies produce less androgen (testosterone), oestrogen and progesterone. By age 40, women produce about half the testosterone they did in their twenties. These levels drop further still with the onset of menopause or for women who have had their ovaries removed. Many clinicians believe that the diminished energy, decreased sexual desire and "flatness" of mood that some women experience during and after menopause are directly related to declining levels of female testosterone.

Doctors traditionally respond to menopausal complaints by dispensing prescriptions for estrogen and progesterone, traditional "female" hormones that address some of the discomforts of menopause and provide the added advantage of protecting against heart disease, Alzheimer's disease and osteoporosis. Although estrogen can quench hot flashes and ease vaginal dryness, it does little to increase low libido or energy.

Several studies suggest, however, that small amounts of androgen added to estrogen replacement therapy can restore sexual desire, improve energy and promote a sense of well-being. When used by women, testosterone also helps prevent bone loss, improves body composition (building lean mass and reducing body fat) and supports cognitive function.

Some clinicians argue that female testosterone is the missing link in hormone replacement therapy. Adding testosterone to the hormonal "cocktail," even for a short period, duplicates "normal hormonal state" and helps women better tolerate estrogen and progesterone.

Studies conducted on women who had their ovaries removed (ovaries produce nearly half of a woman's testosterone), found that when given a combination of testosterone and estrogen, these women were more interested in sexual intercourse. They also experienced more orgasms and greater pleasure.

Some members of the medical community have not embraced androgen therapy for women. Many physicians are reluctant to prescribe androgen because there are relatively few studies on women and testosterone. The long-term effects are unknown. Testosterone in a woman should be used cautiously. Even androgen's most fervent advocates agree that the hormone should be prescribed on a case-by-case basis to menopausal women who are otherwise healthy. They caution that this therapy is not appropriate for women of childbearing age. Not only do younger women produce sufficient androgen, but also excess levels can cause serious damage to a developing foetus.

Think you might be a candidate for androgen therapy?
Here is what to do:

• Request a health screen from your clinician
  Have your female testosterone, DHEA and estrogen levels measured. Normal concentrations of testosterone range from between 25 and 100 nanograms per milliliter of blood. Some clinicians also recommend an at-home saliva test that checks "free" hormone levels (these are the active hormones), not just total levels. The results will enable your health care practitioner to fine-tune your hormonal "cocktail" (prescription) so that it is individualized to your specific needs.
• Eat a well-balanced diet to stabilize your hormones
  Fibres and foods rich in minerals, such as potassium and magnesium can help balance hormones. Tofu, tempeh and other soy products are excellent sources of phytoestrogens, plant compounds that behave like mild estrogens in the body, helping relieve menopausal symptoms. Other sources of phytoestrogens include apples, alfalfa, cherries, potatoes, rice, wheat and yams. A diet rich in fruits and vegetables will also help maintain optimal health as you transition into menopause.

If you begin androgen therapy, be sure to report any side effects to your doctor so he or she can monitor your progress and adjust your dosage as necessary.