New Guidelines Released on Testosterone Use in Women

Testosterone therapy should generally not be used in healthy women, according to a new clinical practice guideline released by the Endocrine Society.

The guideline represents an update from the society’s 2006 recommendations on the therapeutic use of androgens in women in light of new research on testosterone and dehydroepiandrosterone (DHEA) therapy in women and advances in testosterone testing and measurement techniques.

The American Society for Reproductive Medicine, the American Congress of Obstetricians and Gynecologists, the European Society of Endocrinology and the International Menopause Society co-sponsored the guideline.

Recommendations

Specifically, the task force charged with drafting the guidelines recommend against the use of testosterone in women for the following conditions:

• Infertility
• Sexual dysfunction other than hypoactive sexual desire disorder (HSDD)
• Cognitive, cardiovascular (CV), metabolic or bone health
• General well-being

“Although limited research suggests testosterone therapy in menopausal women may be linked to improved sexual function, there are too many unanswered questions to justify prescribing testosterone therapy to otherwise healthy women,” task force chair Margaret E. Wierman, MD, of the University of Colorado in Aurora, said in a press release.

The guideline also recommends against routine use of DHEA, as a meta-analysis and review offered insufficient evidence on safety and efficacy in normal women or those with adrenal insufficiency.

For similar reasons, the task force does not endorse routine prescription of testosterone or DHEA for treatment of women with low androgen levels related to hypopituitarism, adrenal insufficiency, surgical menopause, pharmacological glucocorticoid administration or other conditions associated with low androgen levels.

The data do not demonstrate that treatment improves symptoms and long-term studies on risks are lacking, they wrote in the guideline.

Consistent with previous guidelines, the task force recommends against making a diagnosis of androgen deficiency syndrome in healthy women, citing “a lack of a well-defined syndrome” and the absence of data linking androgen levels with specific symptoms in women.

“When we reviewed past studies, we found many women who had low testosterone levels measured by older or new techniques did not exhibit any signs or symptoms of concern,” Wierman said. “As a result, physicians cannot make a diagnosis of androgen deficiency in women.”