Testosterone Therapy for Low Desire – How, When and Where?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Describe the appropriate use of testosterone therapy 2. List the different routes that can be used for prescribing testosterone
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Currently the only evidence-based indication for testosterone therapy is hypoactive sexual desire disorder (HSDD) in postmenopausal women. As an initial diagnosis, low libido is often based on the medical interview, so the provider needs to spend time questioning the patient to ensure that her complaint is indeed low desire. If other causes for low sexual arousal and desire have been reviewed and subsequently ruled out:
Check testosterone levels prior to beginning therapy to ensure patient is not hyperandrogenic
Prior to initiating testosterone, order liver function tests and a fasting lipid profile to rule out contraindications to use
There are a number of topical products available in varying strengths
In addition to these products, other methods of delivery include pellets or injections
All testosterone preparations are currently being prescribed ‘off-label’ for use in women
Initial topical treatment of testosterone:
Testosterone gel 1% (custom compounded) 0.5 g daily applied topically to arms, thighs and abdomen
1% gel (FDA approved for men) at 1/10 male dose
Measure total testosterone (more reliable than free) intermittently during therapy to prevent overdosing
target levels that of normal range for reproductive-aged women (values vary based on lab)
Stop treatment if no improvement after 3 to 6 months or adverse effects occur
Monitor for androgenic effects (e.g. hirsutism)
While there are a number of ways to deliver testosterone to female patients, topical products are generally used as the first line treatment as they are easy to titrate and may be discontinued if the patient experiences side-effects. Physicians choosing to prescribe testosterone should be clear that treatment can be a slow process and patients may not see results for 4-6 months.
Inform patients of the following prior to initiating therapy
Off-label nature of use
Potential risks and adverse effects
Lack of long-term safety data
High placebo response seen in trials of testosterone therapy should be discussed
Other options for low sexual desire
Concomitant behavioral and psychotherapy can be extremely helpful in the process
While the initial problem may have been physiological, many times behavioral or psychological issues have arisen as a result. A provider may want to consider simultaneous referral to sex therapist while treating the patient
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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