Testosterone replacement therapy (TRT) is a common treatment for women with low testosterone levels, but it can cause unwanted side effects such as hair loss and acne Zitzmann et al., 2024. Understanding the underlying mechanisms of these side effects is crucial for developing effective mitigation strategies.

Hair Loss

Androgenetic alopecia, also known as male or female pattern hair loss, is a common condition that affects both men and women Cuevas-Diaz Duran et al., 2024. In women, hair loss is often associated with hormonal imbalances, particularly an excess of androgens such as testosterone Heilmann-Heimbach et al., 2020. TRT can exacerbate hair loss in women by increasing androgen levels, leading to hair follicle miniaturisation and shortening of successive anagen cycles York et al., 2020.

To mitigate hair loss, combination therapies that include topical finasteride, minoxidil, and low-level laser therapy have shown promise S Nestor et al., 2021. Topical finasteride, in particular, has been found to be safe and effective in reducing hair loss and promoting hair growth Keerti et al., 2023. Additionally, a rotational scheme of combination treatments can help minimise side effects and ensure patient compliance Mysore et al., 2023.

Acne

Acne is another common side effect of TRT in women, particularly those with a history of acne or polycystic ovary syndrome (PCOS) Nandy & Shrivastava, 2024. The exact mechanisms underlying TRT-induced acne are not fully understood, but it is thought to involve increased sebum production, follicular hyperkeratinization, and hormonal imbalances Nandy & Shrivastava, 2024.

To mitigate acne, clinicians may recommend topical or oral retinoids, benzoyl peroxide, or hormonal therapies such as spironolactone C Madsen et al., 2024. In some cases, combination therapies that include testosterone and anti-androgen medications may be effective in reducing acne severity Chu et al., 2023. However, more research is needed to fully understand the effects of TRT on acne and to develop effective treatment strategies.

Personalised Medicine Approaches

Personalised medicine approaches, such as genetic testing and biomarker analysis, may help tailor TRT to individual patients and minimise side effects (Velez & Hwang, 2020). By identifying genetic variants associated with hair loss and acne, clinicians can develop targeted treatment plans that address specific underlying mechanisms Kim & Cheng, 2023. Additionally, biomarker analysis can help monitor treatment response and adjust therapy accordingly de Figueiredo et al., 2023.

Conclusion

Mitigating the side effects of TRT in women requires a comprehensive approach that takes into account individual patient characteristics, medical history, and treatment goals. By understanding the underlying mechanisms of hair loss and acne, clinicians can develop effective treatment strategies that minimise side effects and optimise treatment outcomes. Further research is needed to fully understand the effects of TRT on hair loss and acne and to develop personalised medicine approaches that address these side effects.

References

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