Overview

The study “Testosterone therapy in women: Myths and misconceptions” (Glaser & Dimitrakakis, Maturitas, 2013) reviews medical literature to address and refute ten widespread myths regarding testosterone (T) therapy in women. The authors argue that unfounded concerns prevent women from receiving evidence-based androgen therapy, which is vital for physical, mental, and emotional health.

Key Refuted Myths

1. Myth: Testosterone is strictly a “male” hormone
   • Fact: Testosterone is quantitatively the most abundant active sex steroid in women throughout their lives, circulating at significantly higher levels than estradiol ().
2. Myth: Testosterone only affects libido
   • Fact: Functional androgen receptors are present throughout female body tissues (including the heart, brain, bones, muscles, and lungs). Testosterone is essential for overall physical and mental well-being.
3. Myth: Testosterone causes masculinization in women
   • Fact: At standard physiological and therapeutic doses, testosterone does not cause masculinization. Unwanted androgenic side effects (e.g., mild facial hair growth) are dose-dependent and reversible.
4. Myth: Testosterone causes hoarseness and voice changes
   • Fact: There is no conclusive evidence or biological mechanism showing replacement-dose testosterone causes vocal cord changes or hoarseness. In fact, testosterone deficiency is associated with hoarseness due to inflammatory factors.
5. Myth: Testosterone causes hair loss
   • Fact: Testosterone therapy has been shown to increase scalp hair growth in women. Hair loss is typically influenced by genetics, insulin resistance, or dihydrotestosterone (DHT) rather than testosterone itself.
6. Myth: Testosterone harms the cardiovascular system
   • Fact: Substantial evidence demonstrates testosterone is cardiac-protective. It acts as a vasodilator, improves glucose metabolism and lipid profiles, and supports cardiac muscle health.
7. Myth: Testosterone causes liver damage
   • Fact: While high-dose oral synthetic steroids can affect the liver, non-oral/parenteral testosterone (e.g., subcutaneous implants or patches) bypasses liver metabolism and does not cause liver toxicity or increase clotting factors.
8. Myth: Testosterone causes aggression
   • Fact: Testosterone therapy reduces anxiety, irritability, and aggression in women. Hostility and aggression are more strongly linked to elevated estrogen levels acting on estrogen receptors.
9. Myth: Testosterone increases the risk of breast cancer
   • Fact: Testosterone exerts an anti-estrogenic, growth-inhibiting effect on breast tissue. Clinical evidence indicates that testosterone is breast-protective and does not increase breast cancer risk.
10. Myth: The safety of testosterone in women has not been established
    • Fact: The safety of non-oral testosterone therapy in women is well-established, supported by long-term clinical data spanning over several decades.

Conclusion

The authors conclude that testosterone is critical to female health. Dispelling these ten common misconceptions enables clinicians to better evaluate androgen deficiency in women and offer safe, evidence-based treatments.