Both men and women produce testosterone. The big difference is that the levels are much lower in women, around 15 to 40 ng/dL.  In women, testosterone levels begin to decline gradually after the age of 20. In postmenopausal women, testosterone levels are between 0 and 20 ng/dL.  Various symptoms have been attributed to falling levels of testosterone in midlife women, including lower sex drive, decreased muscle mass and bone density, decline in cognitive functioning, and depression.  Some refer to this constellation of symptoms as “female androgen insufficiency syndrome”; others debate the clinical validity of this diagnosis in women.

Clinically testosterone has been used most commonly in postmenopausal or oophorectomized women in order to improve sexual functioning.   But if you wander around the Internet, you can quickly see that many sites promote the use of testosterone in midlife women, stating that testosterone supplements increase strength and muscle mass, boost energy, treat depression, improve cognition, reverse the effects of aging, and improve overall quality of life.

A new report entitled “Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline,” was published online in the Journal of Clinical Endocrinology and Metabolism. The Society updated its 2006 recommendations concerning testosterone and dehydroepiandrosterone (DHEA) therapy in women.

This report questions the existence of androgen insufficiency syndrome in women, noting that most women with low testosterone levels do not have any specific signs or symptoms.  Importantly, the authors of this report note we have no data regarding the long-term effects of androgen therapy in women.  Use of testosterone in women has been linked to changes in cholesterol levels, as well as acne and hirsutism (excessive growth of hair). Long-term risks to the breast or cardiovascular system are unknown.

The only situation where the Society supports prescribing testosterone therapy is in post-menopausal women diagnosed with Hypoactive Sexual Desire Disorder (HSDD). This condition occurs when a woman has decreased interest in sex, and when this lack of interest causes personal distress. In these situations, the guidelines suggest a three- to six-month trial of testosterone to determine if the therapy improves sexual functioning.

The guidelines discourage the off-label use of testosterone in women to treat low libido and infertility, or for other reasons (e.g., to improve cognitive functioning, mood, or physical well-being).

Ruta Nonacs, MD PhD

 

Wierman ME, Arlt W, Basson R, Davis SR, Miller KK, Murad MH, Rosner W, Santoro N.  Androgen therapy in women: a reappraisal: an endocrine society clinical practice guideline.  J Clin Endocrinol Metab. 2014 Oct; 99(10):3489-510.

Information for Patients: Therapeutic Use of Androgens in Women