The only situation in which prescribing testosterone to women is suggested is in the case of HSDD, which is characterized by a lack of interest in sex that causes personal distress to the patient. A 3- to 6-month trial of testosterone therapy is then warranted to see if sexual function is improved with treatment.

The task force notes, however, that physiological testosterone preparations for use in women are currently not available in many countries, including the United States, and long-term safety data are inadequate. They therefore recommend monitoring for signs of androgen excess in women receiving testosterone therapy.

The Endocrine Society’s clinical practice guideline also recommends against the use of testosterone for off-label purposes in otherwise healthy women, such as improving sexual dysfunction in women without HSDD, because testosterone use has been associated with cholesterol changes, acne and hirsutism, and questions about long-term risks to the breast and CV system remain unanswered, they wrote.

“Currently, there isn’t enough evidence that any benefits outweigh the risks to most women,” Wierman said. “More research is needed to determine the long-term safety of testosterone therapy in postmenopausal women.”

Looking Ahead

Testosterone testing and measurement has come a long way, but the research needs to play catch-up. In the clinical practice guideline, the task force highlights areas for future study and evaluation.

Learning more about the role of androgens in women, for instance, is important.

“We recommend that trials of androgen therapy should assess the safety and risk of androgen administration using multiple endpoints, including sexual function, mood, and cognitive, bone, cardiovascular, dermatological, breast, and endometrial health,” the task force wrote in the guideline.

Further investigation into how testosterone therapy may affect women with female sexual dysfunction would also be helpful. This involves study of women with low sexual interest/incentives and arousal as opposed to those with low desire and the inclusion of women with clinical depression, problematic relationships, partners with sexual dysfunction or poor health.

“Research exploring these psychosocial factors, along with optimal hormonal evaluation, is needed,” the task force wrote.

“Ongoing improvement in androgen assays will allow a redefinition of normal ranges across the lifespan; this may help to clarify the impact of varying concentrations of plasma androgens on the biology, physiology, and psychology in women and lead to indications for therapeutic interventions,” they added.

For more information on androgens in women, visit the Hormone Health Network.

Reference

  1. Wierman ME et al. J Clin Endocrinol Metab. 2014;99:3489-3510.