FAQ: What does the evidence show about testosterone in women?

This FAQ is a summary of the discussion in the first episode of the Special Report series, Testosterone in women: The evidence-practice gap in the US. In the episode, Bruce Dorr, MD, FACOG, URPS, FMCP-M, a board-certified ob-gyn with subspecialty training in urogynecology, and Maria Uloko, MD, a board-certified urologist specializing in comprehensive sexual health, review what the highest-quality evidence does and does not establish about testosterone therapy in women.

Dorr framed the discussion around one question: “What does the highest quality evidence actually establish about testosterone therapy in women and, just as importantly, what doesn't it establish?” The answers below come from the panelists' remarks in the episode.

Which women does the evidence support treating with testosterone?

Uloko said the studies establish the indication for testosterone, meaning who is a candidate based on the evidence available. Looking across the studies, she said, those who benefit most are “postmenopausal women or people that are postmenopausal who are experiencing low desire.”

“So really it's a very niche indication,” Uloko said, adding that it applies to postmenopausal people experiencing low desire.

What has the evidence not shown?

Uloko said the evidence did not show a “statistically significant improvement in sexual function for people that are premenopausal.” It also did not show “any musculoskeletal or cognitive improvement for anyone that is postmenopausal or really along the spectrum,” she said.

How complete is the evidence base?

Uloko attached a caveat to her answer, putting what she called an asterisk around the evidence. “The evidence is not complete, that we still need more and more evidence, but we do have some evidence,” she said.

Does an evidence gap mean women outside the studied group get no benefit?

Not necessarily, according to Dorr. He said, “Just because we don't have evidence doesn't mean women don't get benefit.” The panelists used that tension to set up the rest of the series, which moves from what the studies show to how clinicians apply that evidence, and its limits, with real patients.

This FAQ was developed as a summary of the Special Report series discussion. To hear the full conversation, watch the complete series, Testosterone in women: The evidence-practice gap in the US.