From the Guidelines
Elevated levels of testosterone are not recommended for women in perimenopause due to the potential risks and limited long-term safety data. The primary concern in managing perimenopausal symptoms is to balance the relief of symptoms with the potential risks associated with hormone therapy. According to the guidelines 1, hormone replacement therapy, which includes testosterone, has been associated with a small increased risk of breast cancer and cardiovascular and thromboembolic morbidity, and its routine use is not currently recommended.
Some key points to consider in the management of perimenopausal symptoms include:
- Hormone replacement therapy may be considered in women who experience severe menopausal symptoms, such as vasomotor symptoms and vaginal dryness, but should generally be used only for a limited period of time and at the lowest effective doses 1.
- Testosterone therapy is typically considered for specific symptoms like decreased libido, and if prescribed, is usually given at low doses, such as 0.5-1.0 mg daily, to maintain levels within the normal female range (15-70 ng/dL).
- The side effects of excessive testosterone include acne, hair growth, voice deepening, and potential cardiovascular risks, highlighting the need for careful monitoring and consideration of the risks and benefits.
- Estrogen therapy is more commonly prescribed to address the primary symptoms of perimenopause, and women experiencing perimenopausal symptoms should first discuss comprehensive hormone therapy options with their healthcare provider.
Given the potential risks and the limited long-term safety data for testosterone use in women, a cautious approach is recommended, prioritizing the use of testosterone therapy only when clearly indicated and at the lowest effective doses. This approach is supported by the guidelines 1, which emphasize the importance of weighing the benefits and risks of hormone replacement therapy in the management of perimenopausal symptoms.
From the Research
Testosterone Therapy for Women in Perimenopause
- The use of testosterone therapy for women in perimenopause is not widely recommended, as most studies focus on postmenopausal women 2, 3, 4, 5.
- However, some studies suggest that limited data support the use of testosterone therapy in late reproductive age premenopausal women, including those in perimenopause, for the treatment of hypoactive sexual desire disorder (HSDD) 2, 3, 4.
- A study analyzing claims database found that testosterone prescriptions for HSDD were highly variable, and there was a significant underprescription of testosterone, highlighting the need for further research on the optimal use of testosterone therapy for women with HSDD, including those in perimenopause 6.
- The International Society for the Study of Women's Sexual Health recommends systemic transdermal testosterone for women with HSDD not primarily related to modifiable factors or comorbidities, but notes that long-term safety has not been established 2, 3, 4.
- Testosterone levels should be monitored to maintain concentrations in the physiologic premenopausal range, and patients should be assessed for signs of androgen excess 2, 3, 4.
- Government-approved transdermal male formulations can be used cautiously with dosing appropriate for women, but compounded products cannot be recommended due to lack of efficacy and safety data 2, 3, 4.