Safety of Testosterone Therapy in a 75-Year-Old Female
Testosterone therapy is generally not recommended for 75-year-old females due to insufficient evidence regarding long-term safety and limited FDA approval for this population.
Current Evidence on Testosterone Use in Women
The evidence for testosterone use in older women is limited, with most guidelines focusing on testosterone therapy in men. The available research suggests:
- Safety data for testosterone use in women is primarily from short-term studies (up to 2 years), which is insufficient to establish long-term safety in elderly females 1
- The Endocrine Society has recommended against the generalized use of testosterone in women due to inadequate indications and lack of long-term safety data 2
- The North American Menopause Society notes that testosterone therapy in women should be limited to treating decreased sexual desire with personal distress, with no other identifiable cause 3
Safety Concerns for Elderly Women
Several safety considerations are particularly relevant for a 75-year-old female:
Cardiovascular Risks
- Low-certainty evidence from studies in men showed a possible small increase in adverse cardiovascular events with testosterone treatment 4, 5
- Older adults are already at higher baseline risk for cardiovascular events
- Most studies excluded individuals with recent cardiovascular disease, limiting generalizability to elderly populations 4, 5
Other Potential Adverse Effects
- Fluid retention, which can be problematic for patients with congestive heart failure or renal insufficiency 5
- Possible worsening of sleep apnea 5
- Androgenic side effects including acne and hirsutism 1, 3, 6
- Weight gain has been reported with testosterone treatment 6
Limited Evidence of Benefit in Elderly Women
While some studies show benefits of testosterone in women, these are primarily:
- Focused on sexual function improvements in younger postmenopausal women 3, 6
- Not specifically studied in women of advanced age (75+)
- Not established for other potential benefits such as bone mineral density, hot flashes, lean body mass, or general well-being 3
Monitoring Recommendations If Testosterone Is Used
If testosterone therapy is considered despite these concerns:
- Use the lowest effective dose for the shortest time possible 3
- Prefer transdermal applications over oral formulations due to more favorable lipid profiles 3, 6
- Monitor for:
- Androgenic side effects (acne, hirsutism)
- Cardiovascular parameters
- Lipid profile changes
- Weight changes
- Sleep apnea symptoms
Conclusion
Based on the most recent guidelines and evidence, testosterone therapy carries significant uncertainties regarding safety in a 75-year-old female, with limited evidence of benefit beyond sexual function improvement. The risks likely outweigh potential benefits in this age group, particularly given the lack of long-term safety data and the increased baseline cardiovascular risk in elderly populations.