New Guidelines: Testosterone Therapy Not Recommended in Healthy Women

Healthy women should not be diagnosed with androgen deficiency syndrome, according to a new guideline from the Endocrine Society.

In an update to the 2006 clinical guidelines for the therapeutic use of androgen in women, the Endocrine Society points out lack of evidence and the “lack of a well-defined syndrome.”
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“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,” said Margaret E. Wierman, MD, of the University of Colorado in Aurora, CO, who is vice president of clinical science in the Endocrine Society and chair of the task force that authored the guideline. “As a result, physicians cannot make a diagnosis of androgen deficiency in women.”

A 3 to 6 month trial of testosterone therapy should only be prescribed in women who have been diagnosed with hypoactive sexual desire disorder (HSDD), a condition when a woman has no interest in sex and the lack of interest causes personal distress. Further evidence is needed to determine whether the benefits outweigh the risks.

The guidelines also recommend against the use of testosterone to treat infertility, sexual dysfunction, cognitive, cardiovascular, and metabolic issues, or to promote bone health.

Dehydroepiandrosterone should not be used routinely, due to a lack of data, in either healthy women or those with adrenal deficiency.

Testosterone should also be avoided in the treatment of women low androgen levels due to hypopituitarism, adrenal insufficiency, surgical menopause, pharmacological glucocorticoid administration, due to a lack of sufficient data to support its use.

The full guidelines are published in The Journal of Clinical Endocrinology and Metabolism.

—Michael Potts

Reference:

1. Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(10):3489-3510.

2. Endocine Society. Experts recommend against diagnosing testosterone deficiency in women [press release]. 2014 Oct 3. www.endocrine.org.