Is oral testosterone a recommended treatment for menopause symptoms?

Oral Testosterone is Not Recommended for Menopause Symptoms

Oral testosterone is not recommended for the treatment of menopausal symptoms due to lack of FDA approval, limited efficacy data, and potential safety concerns.

Evidence Against Oral Testosterone for Menopause

Current guidelines do not support the use of oral testosterone for general menopausal symptoms. The FDA specifically contraindicated oral testosterone undecanoate for "age-related hypogonadism" that is not associated with structural or genetic etiologies, citing increased blood pressure and lack of established efficacy 1.

Key Concerns with Oral Testosterone:

• No FDA-approved testosterone formulation exists specifically for women 2, 3
• First-pass hepatic effects documented with oral formulations 2
• Potential for excessive dosing with products formulated for men 2
• Long-term data on cardiovascular, cancer, and cognitive safety are lacking 3

Recommended Approaches for Menopausal Symptoms

First-Line Treatments:

1. Hormone Replacement Therapy (HRT):

   • Transdermal estradiol (preferred over oral formulations) 4
   • Add progesterone if uterus is intact (200 mg daily for 12-14 days per month) 4
   • Use lowest effective dose for shortest duration needed 4

2. Non-Hormonal Options:

   • SSRIs/SNRIs for vasomotor symptoms 1
   • Gabapentin for hot flashes 1
   • Vaginal moisturizers and lubricants for vaginal dryness 1

For Sexual Dysfunction Specifically:

If decreased sexual desire is the primary concern, transdermal testosterone (not oral) may be considered under specific circumstances:

• Only for postmenopausal women with decreased sexual desire associated with personal distress 2
• Only with concomitant estrogen therapy 2
• Only after ruling out other causes (physical, psychosocial factors, medications) 2
• Only using transdermal patches, gels, or creams (not oral formulations) 2, 3
• Only for short-term use (most studies limited to 6 months) 2

Contraindications to Testosterone Therapy

Testosterone therapy is contraindicated in women with:

• Breast or uterine cancer 2
• Cardiovascular disease 2
• Liver disease 2
• Hormone-dependent cancers 4

Monitoring and Side Effects

If transdermal testosterone is used (never oral):

• Monitor for supraphysiologic levels before and during therapy 2
• Watch for androgenic side effects including hirsutism and acne 2, 3
• Assess subjective improvements in sexual response, desire, and satisfaction 2

Special Considerations

For women with systemic lupus erythematosus or positive antiphospholipid antibodies, HRT including testosterone should be avoided or used with extreme caution 1.

Conclusion

For menopausal symptoms, standard HRT with transdermal estradiol (with progesterone if uterus is intact) remains the first-line hormonal treatment. Oral testosterone is not recommended due to safety concerns and lack of FDA approval. If sexual dysfunction is the primary concern, transdermal testosterone (not oral) may be considered in specific circumstances, but only under close medical supervision and with appropriate monitoring.