Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism

Abstract

Objective: To summarize current evidence regarding testosterone treatment for women with low sexual desire. Materials and methods: The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies. Results: Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women. Conclusion: Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. A prospective longitudinal study of serum testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin levels through the menopause transition. J Clin Endocrinol Metab. 2000;85(8):2832-8.

Reposição de testosterona em mulheres cisgênero na menopausa

“…3,5 As doses estudadas na reposição de testosterona assemelham-se aos níveis fisiológicos de mulheres que ainda não passaram pela menopausa, o que se mostra um problema ao prescrever esse tratamento, uma vez que as apresentações comercializadas para a prescrição dessa terapia estão voltadas unicamente para os níveis séricos de testosterona masculinos. 6,8 Portanto, faz-se necessária a realização de estudos que avaliem os efeitos da testosteronaterapia em longo prazo, além da criação de apresentações adequadas aos níveis séricos deste hormônio na mulher. 6,7,8 CONCLUSÃO A reposição de testosterona nas mulheres cisgênero durante a menopausa mostra-se eficaz em curto prazo para disfunções sexuais na pós-menopausa.…”

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

“…Women with HH have androgen deficiency. 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).…”

“…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).…”

Premature ovarian insufficiency: A hormonal treatment approach

“…(22,32) Premature ovarian insufficiency: A hormonal treatment approach Testosterone can be currently prescribed for women with POI diagnosed with hypoactive sexual desire disorder with no contraindication. (33,34) According to the literature, transdermal testosterone adhesive patches delivering 300 mcg/day are associated with an improvement in sexual function, but these are not commercially available in Brazil, being obtained through handling pharmacy. (35)(36)(37) Evidence suggest that testosterone levels should be used for three to six months with clinical and laboratory reassessment of serum testosterone levels (to verify whether the dose is not supraphysiological).…”