The International Society for Sexual Medicine (ISSM), along with the International Society for the Study of Women’s Sexual Health (ISSWSH) and nine other medical organizations, has endorsed the “Global Consensus Position Statement on the Use of Testosterone Therapy for Women.”
The position statement provides guidelines for clinicians who consider prescribing testosterone therapy to female patients.
The practice has been conducted “for decades,” although there have been “no clearly established indications” of testosterone’s use in women, the statement authors wrote. In most countries, prescriptions have been issued off-label, using preparations approved for men but adjusted for women. Compounded therapies have also been used.
The position statement was developed to help healthcare providers better understand the benefits and risks of testosterone in women.
The authors emphasized that treatment of hypoactive sexual desire disorder (HSDD) in postmenopausal women is the “only evidence-based indication for testosterone therapy for women.” There are not enough data to support its use for other conditions or in premenopausal women.
HSDD refers to a decline in sex drive that causes distress, which cannot be easily explained by other health conditions or medication side effects.
Testosterone recommendations were not made for other types of female sexual dysfunction. The authors recommended that women should have a thorough examination before an HSDD diagnosis is made to rule out any contributing factors.
Other highlights of the statement include the following:
- Research has shown that testosterone therapy in postmenopausal women may increase the number of satisfying sexual events each month as well as improve sexual desire, arousal, pleasure, orgasmic function, and responsiveness. Some women have reported less sexual distress.
- Doses should “approximate physiological testosterone concentrations for premenopausal women.”
- Some women who use testosterone may experience side effects like mild acne and body hair growth. Testosterone therapy is not linked to serious adverse events for most women, but it may not be appropriate for all women, such as those at high risk for cardiometabolic disease.
- Oral testosterone may have negative effects on lipid profiles and is not recommended. Non-oral therapies have not shown such effects on lipids.
- There is an “unmet need” for testosterone products approved specifically for women. When preparations for women are not available, a version approved for men may be prescribed, as long as target testosterone levels remain in the physiologic female range.
- Compounded “bioidentical” testosterone is not recommended due to a lack of safety and efficacy data.
- Women who start testosterone therapy should have a baseline level measured with a follow-up measurement taken three to six weeks after the start of treatment. Levels should be assessed every six months afterward. Therapy should stop if no improvements are seen within six months.
- More research is needed to better understand testosterone’s effects on cognitive function, musculoskeletal health, cardiometabolic health, and breast health.
- The safety of long-term testosterone is still unclear.
The statement was drafted in May 2019 in Berlin, Germany and approved unanimously by the panel.
The Journal of Sexual Medicine
Susan R. Davis, MBBS, PhD, et al.
“Global Consensus Position Statement on the Use of Testosterone Therapy for Women”
(Full-text. September 2019)