Testosterone for Women

Discussion in 'Women and Steroids' started by Michael Scally MD, Jul 26, 2019.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    testosterone for Women: Green Light for Sex, Amber Light for Health?

    In 1950, Greenblatt and colleagues published findings of a randomised clinical trial of androgen therapy to manage menopausal symptoms. After removal of the ovaries, postmenopausal women reported improved wellbeing, enhanced libido, decreased hot flushes, and amelioration of other symptoms when treated with methyltestosterone and diethylstilbestrol, versus either hormone alone or a placebo.

    Since then, androgen replacement for women—using effective and safe compounds—has been considered by health-care providers struggling to manage hypoandrogenic symptoms in women and to prevent medical conditions linked to hypoandrogenicity.

    Many testosterone formulations are available to improve measures of sexual wellbeing including low sex drive and poor sexual function. However, currently, these compounds are available only as male formulations and their safety or adverse events, as well as their effect on general aspects of women's health, remain controversial because of scant published data.

    Nappi RE. Testosterone for women: green light for sex, amber light for health? The Lancet Diabetes & Endocrinology. https://doi.org/10.1016/S2213-8587(19)30251-7
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  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Safety and Efficacy of testosterone for Women

    Background - The benefits and risks of testosterone treatment for women with diminished sexual wellbeing remain controversial. We did a systematic review and meta-analysis to assess potential benefits and risks of testosterone for women.

    Methods - We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science for blinded, randomised controlled trials of testosterone treatment of at least 12 weeks' duration completed between Jan 1, 1990, and Dec 10, 2018.

    We also searched drug registration applications to the European Medicine Agency and the US Food and Drug Administration to identify any unpublished data.

    Primary outcomes were the effects of testosterone on sexual function, cardiometabolic variables, cognitive measures, and musculoskeletal health. This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42018104073.

    Findings - Our search strategy retrieved 46 reports of 36 randomised controlled trials comprising 8480 participants.

    Our meta-analysis showed that, compared with placebo or a comparator (eg, oestrogen, with or without progestogen), testosterone significantly increased
    · sexual function, including satisfactory sexual event frequency (mean difference 0·85, 95% CI 0·52 to 1·18),
    · sexual desire (standardised mean difference 0·36, 95% CI 0·22 to 0·50),
    · pleasure (mean difference 6·86, 95% CI 5·19 to 8·52),
    · arousal (standardised mean difference 0·28, 95% CI 0·21 to 0·35),
    · orgasm (standardised mean difference 0·25, 95% CI 0·18 to 0·32),
    · responsiveness (standardised mean difference 0·28, 95% CI 0·21 to 0·35), and
    · self-image (mean difference 5·64, 95% CI 4·03 to 7·26), and
    · reduced sexual concerns (mean difference 8·99, 95% CI 6·90 to 11·08) and distress (standardised mean difference −0·27, 95% CI −0·36 to −0·17) in postmenopausal women.

    A significant rise in the amount of LDL-cholesterol, and reductions in the amounts of total cholesterol, HDL-cholesterol, and triglycerides, were seen with testosterone administered orally, but not when administered non-orally (eg, by transdermal patch or cream). An overall increase in weight was recorded with testosterone treatment.

    No effects of testosterone were reported for body composition, musculoskeletal variables, or cognitive measures, although the number of women who contributed data for these outcomes was small. Testosterone was associated with a significantly greater likelihood of reporting acne and hair growth, but no serious adverse events were recorded.

    Interpretation - Testosterone is effective for postmenopausal women with low sexual desire causing distress, with administration via non-oral routes (eg, transdermal application) preferred because of a neutral lipid profile. The effects of testosterone on individual wellbeing and musculoskeletal and cognitive health, as well as long-term safety, warrant further investigation.

    Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes & Endocrinology. https://doi.org/10.1016/S2213-8587(19)30189-5

    Attached Files:

  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Global Consensus Position Statement on the use of testosterone Therapy for Women

    This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The Royal College of Obstetricians and Gynaecologists, The International Society of Endocrinology, The Endocrine Society of Australia, and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

    The international panel concluded the only evidence-based indication for testosterone therapy for women is for the treatment of HSDD, with available data supporting a moderate therapeutic effect. There are insufficient data to support the use of testosterone for the treatment of any other symptom or clinical condition, or for disease prevention.

    Meta-analyses of the available data show no severe adverse events during physiological testosterone use, with the caveat that women at high cardiometabolic risk were excluded from study populations. The safety of long-term testosterone therapy has not been established.

    It was considered of utmost importance that the diagnosis of HSDD involves a full clinical assessment and that other factors contributing to FSD must be identified and addressed before testosterone therapy is initiated [10,11].

    A blood total testosterone level should not be used to diagnose HSDD. Treatment should only be with formulations that achieve blood concentrations of testosterone that approximate premenopausal physiological concentrations.

    As no approved female product is presently approved by a national regulatory body, male formulations can be judiciously used in female doses and blood testosterone concentrations must be monitored regularly. The panel recommended against the use of compounded testosterone.

    The panel highlighted the pressing need for more research into testosterone therapy for women and the development and licensing of products indicated specifically for women.

    Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the use of Testosterone Therapy for Women. Maturitas 2019. https://www.maturitas.org/article/S0378-5122(19)30628-0/abstract
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  4. Sweetcheeks

    Sweetcheeks Junior Member

    What would help with high estrogen in females?
  5. rand0m

    rand0m Junior Member

    The same damn thing that men use, which of course is primarily made for "females".
  6. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Androgen Therapy in Women

    Androgens are believed to have an important biologic role in women, particularly in regulation of libido and sexual arousal, although much about their function on other systems in women is unknown. testosterone, the primary ovarian androgen, has been used to treat carefully selected postmenopausal women with hypoactive sexual desire disorder (HSDD).

    However, testosterone use in women has not been approved by the United States Food and Drug Administration (FDA) because of uncertainties regarding the effectiveness and long-term safety of this strategy. An intravaginal form of the adrenal androgen, dehydroepiandrosterone (DHEA) has been approved by the FDA to treat genitourinary syndrome of menopause.

    In this article, we review the current knowledge regarding the role of androgens and their clinical use in women. We conducted a systematic search of PubMed for publications describing the role and clinical use of androgens in women. We used the search terms "HSDD," "DHEA in women," "testosterone in women," and "androgens in women," and reviewed most references from all relevant articles.

    Most randomized placebo-controlled trials show an improvement in sexual function with low-dose testosterone therapy in select postmenopausal women with HSDD. Although this strategy appears to be safe in the short term and no major safety concerns have emerged thus far, long-term effects on cardiovascular risk and breast cancer incidence are not known.

    A trial of low-dose testosterone therapy may be considered for carefully selected postmenopausal women with HSDD, as long as other contributors to sexual dysfunction have been adequately addressed. However, patients need careful counseling regarding the lack of long-term safety data, and close clinical and laboratory monitoring of these women is recommended to avoid supraphysiologic dosing.

    Vegunta S, Kling JM, Kapoor E. Androgen Therapy in Women. Journal of women's health (2002) 2019. https://www.liebertpub.com/doi/10.1089/jwh.2018.7494

    Attached Files:

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