From the Guidelines
Testosterone therapy for women should be considered with caution and typically only for those experiencing severe symptoms of low testosterone, with the goal of achieving a total testosterone level in the middle tertile of the normal reference range, as recommended by the most recent guidelines 1. When considering testosterone therapy for women, several options are available, including topical gels, creams, patches, injections, and implantable pellets.
- Topical preparations like AndroGel or compounded testosterone creams (1-2% concentration) are commonly prescribed, applied daily to areas like the inner thigh or upper arm.
- Testosterone patches (Intrinsa) deliver 300 mcg daily.
- Injectable testosterone cypionate or enanthate may be prescribed at 5-20 mg every 2-4 weeks.
- Implantable pellets (25-100 mg) can provide sustained release over 3-6 months. It is essential to monitor treatment with blood tests every 3-6 months to maintain testosterone levels in the upper normal female range (typically 20-60 ng/dL) and watch for side effects, as hormone replacement therapy has been associated with a small increased risk of breast cancer and cardiovascular and thromboembolic morbidity 1. Women should be aware that potential side effects include acne, facial hair growth, deepening voice, and changes in cholesterol levels. The goal of testosterone therapy is the normalization of total testosterone levels combined with improvement in symptoms or signs, and treatment should be stopped if patients do not experience symptomatic relief after reaching the specified target testosterone levels or remain testosterone deficient in the setting of symptom/sign improvement 1.
From the Research
Testosterone Therapy Options for Women
- Testosterone therapy has been used off-label to treat low libido and sexual dysfunction in women for over 40 years 2
- Most clinical trials in postmenopausal women with loss of libido have demonstrated that the addition of testosterone to estrogen significantly improved multiple facets of sexual functioning including libido and sexual desire, arousal, frequency and satisfaction 2
- There are numerous forms of testosterone therapy, such as injectable, transdermal, nasal, and subcutaneous applications 3
- Testosterone undecanoate (TU) is a long-acting ester formulation of testosterone that can be provided in an injectable or oral form, offering a convenient option for many patients 3
- Injectable testosterone undecanoate is marketed as Aveed and Nebido, while oral testosterone undecanoate is marketed as Andriol, Jatenzo, Tlando, and Kyzatrex 3
Safety and Efficacy
- Clinical trials of up to 2 years duration of testosterone therapy have demonstrated that women receiving androgen therapy tolerated androgen administration well and demonstrated no serious side effects 2
- Testosterone therapy in the low-dose regimens is efficacious for the treatment of Women's Sexual Interest and Desire Disorder in postmenopausal women who are adequately estrogenized 2
- The National Institute for Health and Care Excellence guideline on the diagnosis and management of menopause recommends considering testosterone supplementation for women with low sexual desire if hormone replacement therapy (HRT) alone has been ineffective 4
Forms of Testosterone Therapy
- Transdermal testosterone systems, such as Androderm, have been compared to intramuscular testosterone enanthate injections in terms of pharmacokinetics, efficacy, and safety 5
- A long-acting testosterone undecanoate formulation has been compared to testosterone enanthate for intramuscular androgen therapy in male hypogonadism, showing similar efficacy and safety profiles 6