Androgen Therapy in Women
Publication Date: October 1, 2014
Recommendations
Diagnosis of Androgen Deficiency
We recommend against making a clinical 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.
700
Generalized Treatment of Women with Testosterone or Dehydroepiandrosterone (DHEA)
We recommend against the generalized use of T by women for infertility; sexual dysfunction (except for a specific diagnosis of hypoactive sexual desire disorder (HSDD); see recommendation 4.1), cognitive dysfunction, cardiovascular dysfunction, metabolic dysfunction, bone health, or well-being. There are no clear indications for these uses, and evidence of safety in long-term studies is lacking.
In addition, government agency–approved and monitored dose-appropriate preparations are not widely available.
700
We recommend against the generalized use of DHEA for women because the indications are inadequate, and evidence of efficacy and long-term safety are lacking.
700
Treatment of Women with Low Androgen Levels
We recommend against the routine treatment of women with low androgen levels due to hypopituitarism, adrenal insufficiency, bilateral oophorectomy, or other conditions associated with low androgen levels because of the lack of adequate data supporting efficacy and/or long- term safety.
700
We recommend against routinely measuring T in women for diagnosis, because a correlation between symptoms and T levels has not been established.
700
We recommend against the routine use of DHEA therapy in women with adrenal insufficiency because data concerning its effectiveness and safety are limited.
700
Testosterone Therapy for Women with HSDD
We suggest a 3- to 6-month trial of a dose of T for postmenopausal women who request therapy for properly diagnosed HSDD and in whom therapy is not contraindicated resulting in a midnormal premenopausal value in a reference assay to avoid pharmacological T administration.
700
If T therapy is prescribed, we suggest measuring T levels at baseline and after 3–6 weeks of initial treatment to assess patient overuse.
700
In cases of ongoing T therapy, we suggest reviewing T levels every 6 months to monitor for excessive use and signs of androgen excess.
700
We suggest cessation of T therapy for women who have not responded to treatment by 6 months.
No safety and efficacy data for T therapy are available after 24 months.
700
Androgen Therapy and Monitoring
We suggest against the treatment of women with T preparations formulated for men or those formulated by pharmacies due to a lack of data concerning efficacy and safety of these preparations in women.
700
If a woman is to be given a trial of T therapy, we suggest checking baseline T level and the use of an approved non-oral preparation for women (such as a transdermal patch, gel, or cream) if such a treatment is available.
700
We suggest monitoring T levels 3–6 weeks after initiation of therapy and every 6 months thereafter to assess for patient overuse or signs of androgen excess.
700
We suggest cessation of therapy for women who have not responded to treatment by 6 months. Safety and efficacy data for T therapy in women are not available beyond 24 months.
700
Title
Androgen Therapy in Women
Endorsing Organizations
American College of Obstetricians and Gynecologists
American Society for Reproductive Medicine
Publication Month/Year
October 1, 2014
External Publication Status
Published
Country of Publication
US
Document Objectives
To update practice guidelines for the therapeutic use of androgens in women.
Inclusion Criteria
Female, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management, Treatment
Diseases/Conditions (MeSH)
D000728 - Androgens
Source Citation
Margaret E. Wierman, Wiebke Arlt, Rosemary Basson, Susan R. Davis, Karen K. Miller, Mohammad H. Murad, William Rosner, Nanette Santoro, Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 99, Issue 10, 1 October 2014, Pages 3489–3510, https://doi.org/10.1210/jc.2014-2260