The menopause results in acute reductions in circulating levels of oestradiol, and hence standard hormone replacement therapy is oestrogen based. There is now increasing interest in the physiological sequelae to the declining levels of circulating androgens which occur in women with increasing age. Women who have undergone a surgical menopause may experience a variety of physical symptoms secondary to their reduced androgen levels and can be offered testosterone replacement. Women who undergo natural menopause may also have symptoms secondary to androgen depletion and similarly may benefit by the use of testosterone. This review addresses the changes in androgens in women with age and the rationale for physiological androgen replacement as part of a hormone replacement therapy regimen in postmenopausal women.
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