International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women

Abstract

Aim: To provide a clinical practice guideline for the use of testosterone including identification of patients, laboratory testing, dosing, post-treatment monitoring, and follow-up care in women with hypoactive sexual desire disorder (HSDD). Methods: The International Society for the Study of Women's Sexual Health appointed a multidisciplinary panel of experts who performed a literature review of original research, meta-analyses, review papers, and consensus guidelines regarding testosterone use in women. Consensus was reached using a modified Delphi method. Outcomes: A clinically useful guideline following a biopsychosocial assessment and treatment approach for the safe and efficacious use of testosterone in women with HSDD was developed including measurement, indications, formulations, prescribing, dosing, monitoring, and follow-up. Results: Although the Global Position Statement endorses testosterone therapy for only postmenopausal women, limited data also support the use in late reproductive age premenopausal women, consistent with the International Society for the Study of Women's Sexual Health Process of Care for the Management of HSDD. Systemic transdermal testosterone is recommended for women with HSDD not primarily related to modifiable factors or comorbidities such as relationship or mental health problems. Current available research supports a moderate therapeutic benefit. Safety data show no serious adverse events with physiologic testosterone use, but long-term safety has not been established. Before initiation of therapy, clinicians should provide an informed consent. Shared decision-making involves a comprehensive discussion of off-label use, as well as benefits and risks. A total testosterone level should not be used to diagnose HSDD, but as a baseline for monitoring. Government-approved transdermal male formulations can be used cautiously with dosing appropriate for women. Patients should be assessed for signs of androgen excess and total testosterone levels monitored to maintain concentrations in the physiologic premenopausal range. Compounded products cannot be recommended because of the lack of efficacy and safety data. Clinical implications: This clinical practice guideline provides standards for safely prescribing testosterone to women with HSDD, including identification of appropriate patients, dosing, and monitoring. Strengths and limitations: This evidence-based guideline builds on a recently published comprehensive meta-analysis and the Global Position Statement endorsed by numerous societies. The limitation is that testosterone therapy is not approved for women by most regulatory agencies, thereby making prescribing and proper dosing challenging.

Genitourinary Syndrome of Menopause

“…Androgens regulate the epithelium of the vagina and mucin production, which is important for lubrication and sexual response. 32 However, there are limited data that address the safety and efficacy of testosterone cream for the treatment of GSM. A review of 6 clinical trials examined the safety of intravaginal testosterone used to treat VVA.…”

“…Although systemically administered testosterone is prescribed off label for hypoactive sexual desire disorder in women, there are limited studies that have evaluated the use of systemic testosterone for the treatment of GSM. Androgens regulate the epithelium of the vagina and mucin production, which is important for lubrication and sexual response 32 . However, there are limited data that address the safety and efficacy of testosterone cream for the treatment of GSM.…”

Fatigue have impact on the sexual problems in Chinese females with systemic lupus erythematosus

“…Indeed previous study clearly showed that and serum levels of testosterone was significantly lower in SLE patients than control [30], and low androgen was associated with fatigue [31,32] and female sexual dysfunction in previous study [33]. A global consensus statement has recommended the treatment with testosterone in this kind of patients with sexual concerns [34]. Therefore, low androgen level could be the under investigated link between sexual concerns/fatigue and SLE, and testosterone treatment could be a therapeutic option in future study [35].…”

Changes in Sex Steroids and Relation With Menopausal Complaints in Women Undergoing Risk-reducing Salpingo-oophorectomy

“…Notably, testosterone supplements are not available in Europe anymore for postmenopausal women experiencing problems with their sexual functioning. Experts increasingly urge on its potential clinical benefits [ 52 , 53 ], although it should be mentioned that caution should be taken with unwanted aromatization of testosterone to E2 in women with high breast cancer risk (eg, BRCA1/2 mutant carriers).…”