Androgen Therapy in Women

Publication Date: October 1, 2014
Last Updated: March 14, 2022

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

Recommendation Grading

Disclaimer

Overview

Title

Androgen Therapy in Women

Authoring Organization

Endorsing Organizations

Publication Month/Year

October 1, 2014

Last Updated Month/Year

January 10, 2023

Supplemental Implementation Tools

Document Type

Guideline

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

Keywords

androgen

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