Many older women are taking testosterone. Is it safe?

5. TESTOSTERONE SIDE EFFECTS CAN BE IRREVERSIBLE Testosterone can cause side effects, especially at levels above what is typical in women. Common issues include acne and oily skin, hair loss

on the scalp, increased body hair and weight gain. In excessive doses, women may develop more distressing symptoms such as voice deepening, an enlarged clitoris and infertility (in

premenopausal women). In some cases, those changes are irreversible. There are also concerns about breast cancer and cardiovascular risks. 6. CLOSE MONITORING IS IMPORTANT IF YOU TAKE

TESTOSTERONE If you’ve chosen to try testosterone therapy, your health care provider should check your total testosterone level (rather than your “free” testosterone level) before starting

treatment, Kurtzer says. A low level should not be used for diagnosis, according to Kutzner and widely adopted clinical guidelines, because the tests can be unreliable. Plus, testosterone

levels alone don’t clearly indicate whether a woman has sexual dysfunction, the guidelines say. However, testing is important to establish your baseline level before you start therapy and to

help exclude women who already have high levels from getting the therapy. Kutzner also recommends testing liver function, sex hormone-binding globulin (SHBG) levels and a fasting lipid

profile before starting therapy. Your provider should test your testosterone levels again about three to six weeks after starting therapy and six months after therapy to make sure you stay

in the normal range, according to Kurtzer and the guidelines.  To minimize the risk of side effects, she recommends keeping your level under 40 ng/dL. Your provider should also monitor you

for any physical changes that might signal problems. And if you see no improvement after six months, you should stop the treatment. 7. THERE IS NO FDA-APPROVED TESTOSTERONE TREATMENT FOR

WOMEN Although Australia has a 1 percent testosterone cream for women, the FDA has not approved a treatment or dose for women in the United States. That means U.S. providers who want to

prescribe it must either use a compounding pharmacy or prescribe an approved men’s treatment off-label and adjust the dosage down — typically about one-tenth of what men would be prescribed.

A typical prescription would be for a cream or a gel that a woman can apply to her inner knees or the back of her thigh. Insurance usually won’t cover the treatment, which is considered

elective. Costs vary depending on the type of medication, dosage and doctor’s fees. The FDA has approved one related medication, a DHEA-based vaginal suppository called Prasterone

(Intrarosa), for women experiencing pain during sex.  DHEA, a hormone produced by the adrenal glands, plays a role in the production of estrogen and testosterone, but it’s not a testosterone

replacement. 8. BEFORE STARTING TESTOSTERONE, CONSIDER IF SOMETHING ELSE COULD BE SABOTAGING YOUR SEX LIFE Sexual desire is multifaceted, often influenced by emotional, physical and

relationship factors. Before opting for testosterone therapy to address low libido, consider potential underlying causes. Could depression or anxiety be playing a role? Are you taking a

medication that could be suppressing your sex drive? Or are relationship issues affecting intimacy? If you have menopausal symptoms such as hot flashes and night sweats, addressing those

with estrogen/progesterone hormone replacement therapy can often improve sexual function, Yauger says. Prasterone (Intrarosa) is another FDA-approved option that can be beneficial, she says.

Davis also points out that there is a “huge placebo effect” when it comes to sexual health, because the mind plays a crucial role in sexual well-being. Before starting testosterone therapy,

discuss the pros and cons with your healthcare provider and ask about other treatments. Together, you can determine the best approach based on your unique health profile.