Simply looking at the blood levels of estrogen and testosterone 4 may not necessarily tell much about the activity at the cellular level. Neurons containing specific receptors for testosterone are predominantly found in the preoptic area of the hypothalamus. Sex hormone binding globulin may be increased by estrogen replacement and thus testosterone levels may be reduced further. The side effects 5 that concern many people when prescribing androgens are those involving virilisation and hirsutism, including increased muscle mass, bone mass, deepening voice, facial and body hair, acne and male pattern baldness. Clinical evidence shows that such side effects are rare and reversible.
More important concerns are hepatic toxicity and effects on the lipid profile.
No abnormalities have been seen in liver function at the does used in HRT, but the FDA does not recommend that androgen be replaced in women with liver disease. Andriol, an oral agent, is the drug that has been used for androgen replacement therapy in Canada. It is testosterone undecanoate given in a dose of 40 mg on alternate days. It does not have hepatic toxicity and seems to be absorbed through the lymphatics. Hirsutism, does not seem to be a problem.