Global Consensus Guidelines on Use of Testosterone in Women

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 11th 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