That the Androderm patch has suddenly become a topic of conversation on blogs, forums and social media is, for a number of different reasons, of considerable interest. We, therefore, decided to address this subject in this month’s VOICE.
[When reading this article, please consider CHR’s conflict statement here, regarding potential economic conflicts of interest of CHR as well as Drs. Gleicher and Barad regarding androgen supplementation with DHEA and/or testosterone in women with infertility.]
What is Androderm patch?
First, it is important to understand that Androderm patch is a transdermal delivery system for the male hormone testosterone. In principle, it was developed for hypo-androgenic males. Men, of course, have over ten times the testosterone levels of women and, consequently, these patches deliver quite high dosages of testosterone. Second, while Androderm patches are used to raise testosterone levels in women with low functional ovarian reserve in select situations, there is a reason why CHR prefers to use DHEA supplementation to testosterone supplementation: It is how our bodies physiologically produce testosterone.
Testosterone level requirements vary in different organs. If we supplement with testosterone directly, whether by transdermal cream or with patch, we are flooding the whole body with the same levels of the hormone. If we, instead, give DHEA, every organ picks up only as much DHEA (and/or DHEAS) substrate as the organ needs to make the level of testosterone it needs.
Androderm patch for women with LFOR
Ovaries are no exception. Maturing eggs need a healthy level of testosterone in the ovarian microenvironment to reach the ovulation-ready stage in good shape. Ovaries can generally pick up DHEA from the blood and produce this healthy level of testosterone. This is why hypo-androgenic women with low functional ovarian reserve (LFOR) benefit from DHEA/androgen supplementation.
To this, if one adds the observation that DHEA and DHEAS have very low affinity to the androgen receptor (i.e., they hardly function as androgens), it will become clear that androgen supplementation to raise testosterone levels will have much fewer side effects, if done with DHEA than with testosterone directly.
Indeed, too much testosterone in ovaries may be even more harmful than too little. The risk of getting into toxically high levels of testosterone hardly exists when androgen supplementation is done with DHEA but can very quickly arise if too much testosterone is given directly.
For this reason, CHR routinely supplements hypo-androgenic women only with DHEA. Testosterone gel or Androderm patch is added only if testosterone levels do not improve after oral DHEA supplementation, suggesting poor conversion of DHEA to testosterone. Such poor conversion is very rare in Caucasian and Asian women and a little more common, but still rare, in women of African descent. Need for direct testosterone supplementation in women, therefore, should be the exception, a reason why CHR does not recommend the routine use of Androderm patches in women in fertility treatments.