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. Discuss the role of testosterone treatment for sexual disorders in premenopausal and postmenopausal women
2. Describe the impact of testosterone therapy on mood disorders and general wellbeing in postmenopausal women

Estimated time to complete activity: 0.25 hours

Faculty:

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 12/01/2022 through 12/01/2024, 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 test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

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.

Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

Read Disclaimer & Fine Print

SUMMARY:

A global consensus position statement (2019) on the use of testosterone in women was published and endorsed by NAMS, RCOG, RANZCOG, The International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women’s Sexual Health, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The International Society of Endocrinology and The Endocrine Society of Australia.  The statement addresses the available evidence and states

No cut-off blood level can be used for any measured circulating androgen to differentiate women with and without sexual dysfunction

There are insufficient data to make any recommendations regarding the use of testosterone in premenopausal women for treatment of sexual function or any other outcome

The only evidence-based indication for testosterone therapy for women is for the treatment of HSDD, with available data supporting a moderate therapeutic effect, in postmenopausal women

There are insufficient data to support the use of testosterone for the treatment of any other symptom or clinical condition, or for disease prevention

Postmenopausal Women

• Testosterone treatment of hypoactive sexual desire disorder (HSDD) with/or without concurrent estrogen therapy (dosing approximately physiological premenopausal levels) is beneficial for the following (Level 1, Grade A evidence)
  • Increased: Satisfying sexual event (1 per month) | Subdomains of sexual desire, arousal, orgasmic function, pleasure and sexual responsiveness
  • Decreased: Sexual concerns including sexual distress

 Note: Above recommendations and evidence for use of testosterone in HSDD in postmenopausal women are specific for approximate physiologic doses and not supraphysiological that may occur with injectables, pellets or compounded preparations

Benefit of testosterone use has not been found for the following

• Cognition
  • Insufficient evidence
• General wellbeing
  • No effect
• Depression
  • No effect  
• Bone mineral density (spine and hip at 12 months)
  • No effect
• Lean body mass, total body fat or muscle strength
  • No effect (physiologic dosage)

KEY POINTS:

• HSDD diagnosis and female sexual arousal disorder (FSAD)
  • HSDD and FSAD are 2 distinct conditions with clinical overlap but distinct etiologies
• Diagnosis of HSDD should be based on clinical assessement and diagnostic criteria (e.g., ISSWSH or ICD 11^th edition)
• Use of systemic DHEA in postmenopausal women with normal adrenal function is not recommended for HSDD
  • Does not significantly improve libido or sexual function
• Safety

Meta-analyses of the available data show no severe adverse events during physiological testosterone use, with the caveat that women at high cardiometabolic risk were excluded from study populations. The safety of long-term testosterone therapy has not been established.

Learn More – Primary Sources:

Global Consensus Position Statement on the Use of Testosterone Therapy for Women

Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions—Part III (Definitions can be found in Table 1)

Testosterone Therapy in Women: A Clinical Challenge

NAMS Practice Pearl: Testosterone Use for Hypoactive Sexual Desire Disorder
in Postmenopausal Women

Related ObG Topics:

Testosterone Therapy for Low Desire – How, When and Where?

Treatment Options for the Patient with Low Sexual Desire

Does Testosterone Treatment Improve Sexual Function in Women?

Talking to Your Patients About OTC DHEA