When to check testosterone levels in menopausal women?

When to Check Testosterone Levels in Menopausal Women

Testosterone testing is not recommended in menopausal women in non-research settings. 1

Evidence-Based Rationale

• The HIV Medicine Association of the Infectious Diseases Society of America explicitly states that obtaining testosterone levels in women in non-research settings is not recommended (strong recommendation, low quality evidence) 1

• Unlike in men, there is currently no well-defined clinical syndrome of androgen deficiency in women, and there is a lack of normative data on total or free testosterone levels across the lifespan that can be used to define a disorder 2

• The diagnosis of testosterone deficiency in women is hampered by a lack of precise definitions and sensitive assays for testosterone, with precise normal ranges for control populations lacking 3

Clinical Considerations for Specific Scenarios

While routine testing is not recommended, there are specific clinical scenarios where testosterone measurement might be considered:

• In menopausal women with osteoporosis, serum testosterone/SHBG/LH/FSH may be measured as part of additional assessment, particularly if there are other signs of hormonal imbalance 1

• When measuring testosterone in women, it's important to note that:

  • Free testosterone is a better index of gonadal status than total testosterone 1
  • If total testosterone is being measured, it should be expressed as a ratio of SHBG to total testosterone 1
  • A ratio of total testosterone/SHBG (free testosterone index) <0.3 indicates hypogonadism 1

Testosterone and Women's Health

• Low testosterone levels in women have been associated with:

  • Reduced sense of well-being and persistent unexplained fatigue 4
  • Decreased sexual desire, sexual receptivity, and pleasure 4
  • Depression and osteoporosis 5
  • Increased total body fat mass 5

• However, high testosterone levels can also be problematic, associated with:

  • Aggressive behavior 5
  • Depression 5
  • Hirsutism and acne 5

Treatment Considerations

• The NICE Guidelines (2015) state that testosterone supplementation can be considered for menopausal women with low sexual desire if hormone replacement therapy alone is not effective 6

• Despite potential benefits, the Endocrine Society recommends against the generalized use of testosterone by women because the indications are inadequate and evidence of safety in long-term studies is lacking 2

Common Pitfalls to Avoid

• Relying on non-specific symptoms alone to diagnose testosterone deficiency in women 4

• Using insensitive testosterone assays that may not accurately measure the typically lower levels found in women 4

• Failing to recognize that normal women experience a 50% decline in androgen levels from their early 20s to mid-40s, which may contribute to age-related androgen insufficiency 4

• Making treatment decisions based on a single testosterone measurement rather than considering the overall clinical picture 2