Can testosterone levels be treated in women with endometriosis?

Testosterone Treatment in Women with Endometriosis

Testosterone treatment is not recommended for women with endometriosis as it is not supported by high-quality evidence and carries unclear long-term health effects. 1

Current Evidence on Testosterone in Endometriosis

While there is some historical and emerging evidence regarding testosterone and endometriosis, current clinical guidelines do not support testosterone as a primary treatment option:

• The ESHRE guideline clearly states that androgen treatment (including testosterone) is only supported by limited data, and long-term health effects remain unclear 1
• If androgen therapy is ever considered, treatment effect should be evaluated after 3-6 months and should possibly be limited to 24 months maximum 1
• ACOG recommendations for endometriosis management do not include testosterone among their evidence-based treatments 1

Recommended Treatment Options for Endometriosis

Current guidelines recommend the following evidence-based treatments for endometriosis:

First-line Medical Therapies (Level A/B Evidence)

• GnRH agonists for at least three months 1
• Danazol for at least six months 1
• Oral contraceptives 1
• Oral or depot medroxyprogesterone acetate 1
• NSAIDs for pain management 1

For Women Who Have Had Oophorectomy

• Combined estrogen/progestogen therapy is effective for vasomotor symptoms and may reduce disease reactivation risk 1

Why Testosterone Is Not Recommended

1. Limited Evidence Base: Current guidelines emphasize that androgen treatments have insufficient supporting data 1

2. Unknown Long-term Effects: The long-term health consequences of testosterone treatment in women with endometriosis are not well established 1

3. Better Alternatives Exist: Several well-studied alternatives with stronger evidence bases are available 1

4. Monitoring Challenges: If testosterone were used, it would require careful monitoring and time-limited treatment 1

Emerging Research

Recent research suggests some interesting connections between testosterone and endometriosis:

• Some studies indicate an inverse relationship between testosterone levels and endometriosis, with lower testosterone levels potentially associated with endometriosis and increased pain sensitivity 2
• In transmasculine individuals receiving testosterone therapy, there may be potential benefits for endometriosis symptoms 3

However, these findings are preliminary and have not yet translated into evidence-based clinical recommendations.

Clinical Approach to Endometriosis Management

For women with endometriosis requiring treatment:

1. First-line options:

   • GnRH agonists (with add-back therapy to prevent bone loss) 1
   • Combined hormonal contraceptives 1
   • Progestins 1

2. For severe endometriosis:

   • Medical treatment alone may not be sufficient 1
   • Surgical options should be considered 1

3. For women post-oophorectomy:

   • Combined estrogen/progestogen therapy is recommended 1

Important Caveats

• Historical use of testosterone for endometriosis (mentioned in older literature) 4, 5 has been superseded by treatments with stronger evidence bases
• Continuous combined hormone preparations or tibolone appear to be optimal choices for women requiring HRT after surgical treatment for endometriosis 6
• Unopposed estrogen carries a higher risk of endometriosis recurrence than combined preparations 6

In conclusion, while testosterone has historical use in endometriosis treatment and some emerging research suggests potential connections, current clinical guidelines do not support testosterone as a recommended treatment for women with endometriosis due to limited evidence and unclear long-term effects.