Androgen Therapy in Women

International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women

“…They should explain that for women it is an off-label therapy, counsel regarding the benefits and risks through shared decision-making recognizing patient's goals and concerns, and provide detailed documentation of the discussion. 140,141 Dosing should be targeted to achieve testosterone concentrations in the physiologic premenopausal range. In a study of premenopausal women with no complaints of sexual dysfunction intended to define normal female androgen values, women aged 20-29 years, 30-39 years, and 40-49 years had testosterone values ranging from 45.5 to 57.5 ng/dl, 27.6 to 39.8 ng/dl, and 27.0 to 38.6 ng/dl, respectively.…”

“…144 Patients should be monitored for clinical response to treatment, including increase in sexual desire and decrease in personal distress. 140 Based on clinical trial data, they should be counseled that on average efficacy emerges 6-8 weeks after initiation of therapy, but many women feel improvement after 4 weeks. 123 Maximal effects in sexual desire and satisfactory sexual events occur at about 12 weeks.…”

Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism

“…Although few studies have shown advantages with treatment (84), recent guidelines recommended against the routine use of DHEA and testosterone in women due to limited data concerning efficacy and safety (30,85,86). An intravaginal form of DHEA has been approved by the FDA to treat genitourinary syndrome of menopause, but this formulation is not available in Brazil (87). Moreover, testosterone has been carefully suggested in the guidelines to treat selected women with hypoactive sexual desire disorder (85)(86)(87).…”

“…An intravaginal form of DHEA has been approved by the FDA to treat genitourinary syndrome of menopause, but this formulation is not available in Brazil (87). Moreover, testosterone has been carefully suggested in the guidelines to treat selected women with hypoactive sexual desire disorder (85)(86)(87). In this clinical context, which might be present in women with hypopituitarism, a trial of low-dose testosterone therapy may be considered, which seems to be safe in the short term.…”

“…However, efficacy is variable and long-term effects on cardiovascular risk and breast cancer incidence are not known. Undesirable side effects, such as alopecia, changes in vocal timbre, hirsutism, clitoromegaly, acne, elevated hematocrit, and liver function and lipid profile abnormalities, must be balanced against the potential benefits (85)(86)(87).…”