From the Guidelines
For premenopausal women with low testosterone levels, hormonal replacement therapy (HRT) with estrogen and progestin is recommended, but testosterone replacement therapy may also be considered in specific cases where low testosterone levels are the primary concern, as there is limited evidence to support its use in premenopausal women. When considering treatment for premenopausal women with low testosterone levels, it's essential to evaluate the underlying causes of the condition, such as hypothalamic-pituitary disorders, adrenal insufficiency, or ovarian dysfunction 1. In cases where HRT is prescribed, the dose of 17βE should be adjusted according to each woman's tolerance and feeling of wellbeing, and progestins with an anti-androgenic effect should be avoided to prevent worsening hypoandrogenism 1. Key points to consider when treating premenopausal women with low testosterone levels include:
- Evaluating the underlying causes of low testosterone levels
- Considering HRT with estrogen and progestin as a first-line treatment
- Avoiding progestins with anti-androgenic effects
- Monitoring treatment regularly to check for side effects and adjust doses as needed
- Continuation of HRT until the average age of spontaneous menopause (45-55 years), with individualized decisions to stop or continue HRT based on risks, family history, and menopausal symptoms 1. It's crucial to note that the evidence for testosterone replacement therapy in premenopausal women is limited, and treatment should be approached with caution, considering the potential risks and benefits, as well as the individual patient's needs and medical history 1.
From the Research
Treatment Options for Premenopausal Women with Low Testosterone Levels
- The treatment of premenopausal women with low testosterone levels is a complex issue, with limited data available to support its use 2.
- Some studies suggest that testosterone therapy may be beneficial for premenopausal women with low libido, but the evidence is not conclusive 3, 4.
- Testosterone deficiency in premenopausal women may be underdiagnosed due to nonspecific symptoms and inaccurate measurement of total and free testosterone 2.
- Common adverse effects of testosterone therapy include hirsutism and acne, which reverse with discontinuation of treatment 2.
- There is no approved testosterone preparation available for women, and off-label use of testosterone products or compounded therapy raises safety concerns 5, 6.
Evaluation of Testosterone Serum Levels
- The relationship between testosterone serum levels and libido in premenopausal women is not well established, with some studies failing to show a significant association 4.
- The measurement of total and free testosterone is inaccurate with commonly used techniques, making it difficult to diagnose testosterone deficiency in premenopausal women 2.