Testosterone Therapy for Women Without Progesterone
Yes, women can be prescribed testosterone without progesterone, as there is no medical requirement to combine these hormones. 1, 2
Rationale for Testosterone Use in Women
Testosterone plays an important role in women's health, particularly for:
- Sexual function, especially libido and desire 3, 4
- Energy levels and sense of well-being 5, 3
- Potentially addressing symptoms of androgen insufficiency 3, 6
Evidence Supporting Independent Testosterone Use
- Testosterone is a normal female hormone with physiological roles separate from progesterone 7
- Clinical trials have demonstrated benefits of testosterone therapy for specific conditions like hypoactive sexual desire disorder (HSDD) in postmenopausal women 3, 4
- The North American Menopause Society recognizes testosterone's positive effects on sexual function in women after menopause 6
Clinical Considerations
Indications
- Primary indication: Decreased sexual desire with personal distress 6
- May be considered for women with symptoms of androgen insufficiency 3
Administration
- Preferred formulations: Transdermal patches, topical gels or creams 6
- Avoid oral formulations due to first-pass hepatic effects 6
- No FDA-approved testosterone products specifically for women exist in the US, despite 31 different preparations approved for men 2
Monitoring
- Monitor for supraphysiologic testosterone levels 6
- Assess for clinical improvement in symptoms 6
- Watch for potential adverse effects like hirsutism and acne 6
Important Caveats
- Testosterone therapy in women is currently off-label in the US 2, 4
- Long-term safety data regarding cardiovascular risk and breast cancer risk are limited 4
- Custom-compounded products should be used with caution due to potential dosing inconsistencies 6
- Testosterone products formulated for men risk excessive dosing for women 6
Contraindications
Testosterone therapy is contraindicated in women with:
Clinical Context
While progesterone is required when using estrogen in women with an intact uterus (to prevent endometrial cancer) 5, there is no similar requirement to pair testosterone with progesterone. The decision to use testosterone therapy should be based on specific symptoms and clinical presentation rather than a mandatory combination with other hormones.
It's worth noting that testosterone therapy should be administered at the lowest effective dose for the shortest duration needed to meet treatment goals 6, with careful counseling about potential risks and benefits.