An important and to date not clearly resolved question in clinical reproductive medicine has been whether premature loss of ovarian function (e.g. primary ovarian insufficiency (POI) below the age of 40 years) and iatrogenic premature loss of ovarian function (as a result of surgery, gonadotoxic chemotherapy or pelvic irradiation) result in a significant decrease in circulating testosterone concentrations and hence might merit testosterone treatment. Many published studies have included small sample sizes and/or non-uniform control groups. Janse and colleagues  have undertaken a systematic review and meta-analysis of the literature and conclude that testosterone levels are lower, though the magnitude of the difference is relatively small. They reviewed 206 articles on POI and 1358 on iatrogenic menopause, of which nine and 17, respectively, were selected for final analysis. In both groups, there was evidence of a lower testosterone concentration than in controls. Weighted mean differences were -0.38 nmol/l (95% confidence interval (CI) -0.55 to -0.22) and -0.29 nmol/l (95% CI -0.39 to -0.18), respectively. The mean differences represented a range of 1–49% lower (average 25%) in POI and a range of 11% higher to 77% lower (average 22% lower) for iatrogenic menopause. A sensitivity analysis of the three highest-quality studies in each group did not change the data substantially. The significance of such relatively small differences and their clinical importance are unclear.
Emeritus Director, Prince Henrys Institute of Medical Research, Clayton, Victoria, Australia
Janse F, Tanahatoe SJ, Eijkemans MJC, Fauser BCJM. Testosterone concentrations, using different assays, in different types of ovarian insufficiency: a systematic review and meta-analysis. Hum Reprod Update 2012, April 23. Epub ahead of print.
Burger HG, Dudley EC, Cui J, Dennerstein L, Hopper JL. A prospective longitudinal study of serum testosterone dehydroepiandrosterone sulphate and sex hormone binding globulin levels through the menopause transition. J Clin Endocrinol Metab 2000;85:2832-8.
Alexander JL, Dennerstein L, Burger H, Graziottin A. Testosterone and libido in surgically and naturally menopausal women. Womens Health 2006;2:459-77.
Davis SR, Davison SL, Donath S, Bell RJ. Circulating androgen levels and self-reported sexual function in women. JAMA 2005;294:91-6.
Basson R, Brotto LA, Petkau AJ, Labrie F. Role of androgens in womens sexual dysfunction. Menopause 2010;17:962-71.
Bachmann G, Bancroft J, Braunstein G, et al. Female androgen insufficiency: the Princeton Consensus Statement on Definition, Classification and Assessment. Fertil Steril 2002;77:660-5.
Kalantaridou SN, Vanderhoof VH, Calis KA, et al. Sexual function in young women with spontaneous 46,XX primary ovarian insufficiency. Fertil Steril 2008;90:1805-11.
Davis SR, van der Mooren MJ, van Lumsen RH, et al. Efficacy and safety of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized placebo controlled trial. Menopause 2006;13:387-96.
Panay N, Fenton A. The role of testosterone in women. Climacteric 2009;12:185-7.
Somboonporn W, Davis SR. Testosterone effects on the breast: implications for testosterone therapy for women. Endocr Rev 2004;25:374-88.