Testosterone Therapy for Women ⋆ Meno Martha

“Research shows that testosterone therapy may
be a suitable treatment for postmenopausal women who
are experiencing a loss of sexual desire that is causing…”.¹

Umbrella
What may the Testosterone Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

Androgen
Male Androgen Hormone
Male Hormone
Male Sex Hormone
Testosterone
Testosterone Therapy/Treatment

Testosterone

What is testosterone?

DotS the definition of testosterone may vary. The Australian Menopause Society’s (AMS) definition is:

“Testosterone is the male sex hormone found in smaller amounts in women. In women, increased levels of testosterone can lead to acne and hirsutism. Low levels of testosterone in women may contribute to loss of libido”.²

Female Hormone

Is testosterone a female hormone?

On page one in Testosterone Replacement In Menopause: Is Testosterone A Female Hormone? the British Menopause Society (BMS) elaborate on:

“Yes – premenopausal women produce both testosterone and estrogen physiologically. Androgens, including testosterone, are essential for development and maintenance of female sexual anatomy and physiology, and modulation of sexual behaviour”.³

Women, Testosterone Levels and Age

In women, is there an association between testosterone levels and age?

In Libido: Managing & Treating Low Libido – Testosterone Therapy the (Australian) Jean Hailes for Women’s Health (JH) explain:

“Testosterone levels fall as a woman ages, with levels approximately 25% less in her 40s compared to what she had in her 20s. The levels reach their lowest around early 60s then stabilise or slightly rise for the rest of a woman’s life”.⁴

Low Libido

In women, is testosterone recommended for low libido, low desire or low sex drive?

In Libido: Managing & Treating Low Libido – Testosterone Therapy the JH elaborate on:

“Low desire and low desire causing distress is very common especially for women around midlife. Some women seeking help from their doctors about their sexual function have low testosterone levels but the relationship between testosterone and libido is complex. Factors like age, mood, general wellbeing and sexual relationships need to be considered”.⁵

In Low Sex Drive In Women: Diagnosis & Treatment – Treatment: Hormone Therapy the (United States) Mayo Clinic elaborate on:

“Testosterone. The male hormone testosterone plays an important role in female sexual function, even though testosterone occurs in much lower amounts in women. Testosterone isn’t approved by the FDA for sexual dysfunction in women, but sometimes it’s prescribed off-label to help lift a lagging libido. The use of testosterone in women is controversial. Taking it can cause acne, excess body hair, and mood or personality changes”.⁶

What is FDA?

FDA can be an abbreviation for the (United States) Food and Drug Administration.

HSDD

In women, what is Hypoactive Sexual Desire Disorder (HSDD)?

DotS the definition of HSDD may vary. In What Is Hypoactive Sexual Desire Disorder (HSDD) In Women? What Causes It? the International Society for Sexual Medicine’s definition is:

“Hypoactive sexual desire disorder (HSDD) is a troublesome condition in which women lose interest in sex. The Society for Women’s Health Research estimates that one in ten women have HSDD, making it one of the most common female sexual health complaints”.⁷

In Low Sex Drive In Women: Diagnosis & Treatment – Diagnosis the Mayo Clinic explain:

“By definition, you may be diagnosed with hypoactive sexual desire disorder if you frequently lack sexual thoughts or desire, and the absence of these feelings causes personal distress. Whether you fit this medical diagnosis or not, your doctor can look for reasons that your sex drive isn’t as high as you’d like and find ways to help”.⁸

Postmenopause + HSDD

For postmenopausal women experiencing HSDD, may testosterone therapy be a suitable treatment?

In Libido: Managing & Treating Low Libido – Testosterone Therapy the JH note:

“Research shows that testosterone therapy may be a suitable treatment for postmenopausal women who are experiencing a loss of sexual desire that is causing them personal distress. This condition is known as hypoactive sexual desire disorder (HSDD)”.⁹

On page one in Testosterone for Women: Why Use Testosterone? the British Women’s Health Concern elaborate on:

“The current recommended reason is for persistent low sex drive (Hypoactive sexual desire disorder, HSDD) in women after all other possible factors, including taking adequate estrogen, have been addressed. Even with this indication, it does not help everyone”.¹⁰

On page one in Testosterone and the Menopause: testosterone Replacement In Women, published July 2022, the European Menopause and Andropause Society note:

“HSDD after the menopause is the only evidence-based indication for testosterone in women”.¹¹

BMS Statement on Testosterone, 02 March 2023

What does the BMS Statement on Testosterone, 02 March 2023, elaborate on for the treatment of low libido?

The BMS Statement on Testosterone elaborates on:

“The current controversy surrounding testosterone treatment is causing confusion amongst women and healthcare professionals alike. British Menopause Society guidance follows NICE NG23 which recommends that testosterone is used for low libido after other options have been exhausted.

Levels of testosterone in women decline between the ages of 20 and 40. By menopause the levels have plateaued out and are stable. Testosterone is produced by the adrenal glands and the ovaries in peri and post-menopausal women. Testosterone is not the third component of HRT and promoting misinformation is creating unrealistic expectations for women, some of whom have challenging social circumstances. Managing women with hypoactive sexual desire disorder, necessitates a biopsychosocial approach. It is important to consider contributory factors which include vulvovaginal atrophy and relationship issues”.¹²

Testosterone Therapy In Women: A Clinical Challenge, 2021

What does the Conclusion note in 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?

The Conclusion in 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, published April 2021, notes:

“Conclusion

…Using established clinical guidance, such as the ISSWSH POC for the management of HSDD, the diagnosis should include a thorough biopsychosocial clinical assessment that leads to identification, modification, and management of contributing factors before testosterone therapy is considered. Before initiation of therapy, patients should receive informed consent, and shared decision-making should involve a comprehensive discussion of off-label use, as well as benefits and risks. …”.¹³

Global Consensus Position Statement on the Use of Testosterone Therapy for Women, 2019

What is the conclusion of the Global Consensus Statement on the Use of Testosterone Therapy for Women?

The conclusion on page five in the first Global Consensus Statement on the Use of Testosterone Therapy for Women – endorsed by 11 menopause-related organizations – published online 02 September 2019, includes:

“Summary and Key Messages

The international panel concluded the only evidence-based indication for testosterone therapy for women is for the treatment of HSDD, with available data supporting a moderate therapeutic effect, in postmenopausal women. There are insufficient data to support the use of testosterone for the treatment of any other symptom or clinical condition, or for disease prevention”.¹⁴

Testosterone Podcasts/Videos

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Testosterone Podcasts/Videos

Low Mood and Depression

Is there a role for testosterone therapy for low mood or depression?

In Looking After Yourself: Managing Low Libido – Testosterone Therapy the JH explain:

“Testosterone therapy is only recommended for women diagnosed with HSDD. There is no evidence to support using testosterone in premenopausal women for low libido or any other condition such as low mood or depression”.¹⁵

On page four in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published online 10 June 2022, one of the recommendations is:

“There is lack of evidence to support testosterone supplementation for the purpose of prevention or improving cognitive function, musculoskeletal health, improving bone density or fracture prevention. Testosterone supplementations should therefore not be offered for these indications”.¹⁶

Health Care Provider

What if I am considering testosterone therapy?

If you are considering testosterone therapy, it may be in your best interest to choose to talk to your health care provider about this.

In Looking After Yourself: Managing Low Libido – Testosterone Therapy: How Is Testosterone Used? the JH note:

“If testosterone therapy is going to improve your libido, you will start to notice this after about four weeks. If there is no improvement after six months, you should stop testosterone treatment”.¹⁷

Health Topics A-Z

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Health Topics A-Z

Links

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Links

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Sources

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