Hold Off on Prescribing Testosterone to Women

October 15, 2014

Experts advise against any off-label prescribing of testosterone for women, unless they are postmenopausal with a low sex drive.

Prescribing testosterone therapy in healthy women is not supported by medical evidence and clinicians should refrain from the practice, according to experts from the Endocrine Society.

The society issued a new clinical guideline on the subject this month in an effort to address the off-label practice of prescribing testosterone to women with low levels but who are otherwise healthy.

Key Points

- The Endocrine Society continues to recommend against the use of DHEA and testosterone therapy in healthy women.

- The one exception: postmenopausal women with hypoactive sexual desire disorder.

“We continue to recommend against making a diagnosis of androgen deficiency syndrome in healthy women because there is a lack of a well-defined syndrome, and data correlating androgen levels with specific signs or symptoms are unavailable,” the authors wrote.

The authors noted that while there is limited research suggesting testosterone therapy in menopausal women may improve sexual function, too many questions remain. Testosterone treatment in women can lead to unwanted side effects, such as acne and hirsutism, the authors noted. In addition, scientists have yet to determine the long-term risks of the therapy to the health of women’s breasts and cardiovascular system.

"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, in a prepared release. She also is the Society's Vice President of Clinical Science and chair of the task force that authored the guideline. "As a result, physicians cannot make a diagnosis of androgen deficiency in women."

In setting the guidelines, the society left room for one exception: the treatment of hypoactive sexual desire disorder in postmenopausal women. Wierman and colleagues found that in those cases, a 3- to 6-month trial period of testosterone therapy is warranted.

In developing the guidance, the authors also reviewed the use of DHEA therapy and concluded there is no significant benefit when given to healthy women or those with adrenal insufficiency. As a result, the task force also did not recommend treatment of women with DHEA.

Even as the task force sought to halt the use of testosterone and DHEA therapy, they acknowledged that more research is needed to fully understand the role of testosterone in women. The task force did not entirely discount the use of testosterone therapy as a potential treatment regime; instead, it called for additional research into the long-term safety of using it in postmenopausal women.