Global Consensus Guidelines on Use of Testosterone in Women
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
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
Bone mineral density (spine and hip at 12
mass, total body fat or muscle strength
effect (physiologic dosage)
HSDD diagnosis and female sexual arousal
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
Use of systemic DHEA in postmenopausal women
with normal adrenal function is not recommended for HSDD
Does not significantly improve libido or sexual
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.
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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.
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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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