As we age, the body produces lower levels of key sex hormones. In men, this is sometimes referred to as andropause or androgen decline in the older male (ADAM). In women, this is known as menopause. Both testosterone and estrogen naturally decrease, resulting in sexual dysfunction, urinary system problemsmuscle loss, loss of bone density (osteoporosis), hair loss, and an increased risk of heart problems and type II diabetes.
Testosterone Replacement Therapy (TRT)also known as systemic testosterone replacement, it is used to restore the body’s natural testosterone levels to the normal range in people with testosterone deficiency. This can help improve sexual and urological dysfunction that men and women may experience along with other age-related physiological changes. TRT can come as a transdermal solution (through the skin) via patches, gels, or pellets, or as an intramuscular injection.
Men’s Sexual Health
TRT’s primary use is to improve male sexual function, and it is currently only approved by the US Food and Drug Administration (FDA) for use in testosterone-deficient men. Men tend to prefer the intramuscular injection for TRT.
Regarding sexual dysfunction, TRT can improve sex drive (libido), erectile dysfunction (ED)lower urinary tract symptoms such as urinary incontinence or frequency, and may have some effect on benign prostatic hyperplasia (BPH, enlarged prostate) – although research has also shown negative effects.
TRT may also help improve other aspects of andropause, such as muscle and bone strength, the risk of type II diabetes, and, from early research, heart problems. Andropause can also affect mood, energy and general well-being, so addressing these symptoms can improve men’s quality of life.
Despite its benefits, TRT can have some less than satisfactory results, which require consistent monitoring. For one, TRT can lower sperm count, potentially reducing fertility. Those who want to preserve fertility may want to discuss other options with their health care provider first.
The number of red blood cells can also increase with TRT (polycythemia), which can increase the risk of stroke, heart attack, blocked arteries in the lungs (pulmonary embolism), and serious blood clots (deep vein thrombosis).
Sometimes, testosterone misbehaves, instead converting to estrogen. This can cause men to develop breast tissue (gynaecomastia). In addition, TRT can increase the skin’s oil production, leading to acne. Although not serious, these side effects can be bothersome and should be discussed with a healthcare provider.
Recent research shows that TRT does not increase the risk of high-grade prostate cancer. Your provider can discuss the risks and benefits with you
Women’s Sexual Health
Estrogen is known as the primary female sex hormone and is currently the gold standard treatment for menopausal conditions. However, testosterone also plays an important role in women’s sexual function. During menopause, women’s estrogen and testosterone levels drop rapidly, resulting in genitourinary menopause syndrome (GSM), which includes a variety of sexual health issues:
With menopause, women may also experience mood swings, hot flashes, and other physical changes.
Despite its use for female sexual dysfunction for decades, a 2019 global consensus statement provides the only recommended use of TRT for women: to treat hyperactive sexual desire disorder (HSDD)a psychological condition that causes a low sex drive that is painful. Because TRT is only FDA-approved for men, it can be prescribed in adjusted doses or in combination with other hormones, allowing it to last longer. Women tend to prefer the gel option.
Recently, a review by the International Society for the Study of Women’s Sexual Health (ISSWSH) expert panel found that at tailored doses, vaginal TRT may be beneficial in relieving GSM symptoms. However, more research is needed to confirm any side effects, and estrogen therapy remains the gold standard for the treatment of GSM.
Basic Takeaways
- The fall in sex hormones (andropause and menopause) is natural as people age.
- Testosterone plays a key role in the sexual and general health of both men and women.
- TRT restores natural testosterone levels to those of a young adult.
- This helps improve sexual function, muscle and bone strength, and reduces the risk of other age-related health conditions.
- TRT is currently only FDA approved for men and is available in male dosages.
- Women can heal HSDD or GSM with testosterone, so doses should be adjusted.
- If aging causes sexual health concerns, it can be beneficial talk to a sexual health professional
Resources:
Davis, SR, Baber, R., Panay, N., Bitzer, J., Perez, SC, Islam, RM, Kaunitz, AM, Kingsberg, SA, Lambrinoudaki, I., Liu, J., Parish, SJ, Pinkerton, J., Rymer, J., Simon, JA, Vignoz Global consensus position statement on the use of testosterone therapy for women. The Journal of Clinical Endocrinology & Metabolism, 104(10), 4660–4666.
Morley, J., Bassil, N., & Alkaade, S. (2009). The benefits and risks of testosterone replacement therapy: A review. Therapeutic and Clinical Risk Management427.
Parish, SJ, Simon, JA, Davis, SR, Giraldi, A., Goldstein, I., Goldstein, SW, Kim, NN, Kingsberg, SA, Morgentaler, A., Nappi, RE, Park, K., Stuenkel, CA, Traish, AM, & Vignozzi, L. (2021). International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women. The Journal of Sexual Medicine, 18(5), 849–867.
Ramasamy, R., Osterberg, Ec., & Bernie, A. (2014). Risks of testosterone replacement therapy in men. Indian Journal of Urology, 30(1), 2.
Simon, JA, Goldstein, I., Kim, NN, Davis, SR, Kellogg-Spadt, S., Lowenstein, L., Pinkerton, JV, Stuenkel, CA, Traish, AM, Archer, DF, Bachmann, G., Goldstein, AT, Nappi, RE, & Zizi, L. (2008). The role of androgens in the treatment of the genitourinary syndrome of menopause (GSM): International Society for the Study of Women’s Sexual Health (ISSWSH) consensus panel. Menopause, 25(7), 837–847.
Sizar O, Leslie SW, Pico J. Androgen Replacement. [Updated 2023 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from:
Uloko, M., Rahman, F., Puri, LI, & Rubin, RS (2022). The clinical management of testosterone replacement therapy in postmenopausal women with hypoactive sexual desire disorder: A review. International Journal of Impotence Research, 34(7), 635–641.
