User login
Testosterone supplementation is not recommended for women, unless they have a clinical diagnosis of hypoactive sexual desire disorder, a joint task force led by the Endocrine Society has determined.
While a number of studies have shown that testosterone supplementation helps improve sexual desire, cognition, and other outcomes, most are either too small, too short, or confounded by other factors to provide irrefutable evidence of the hormone’s benefit for any indication other than hypoactive sexual desire disorder (HSDD), Dr. Margaret E. Wierman and her colleagues wrote in the Journal of Clinical Endocrinology and Metabolism (J. Clin. Endocrinol. Metab. 2014;99:3489-510).
A trial of testosterone is only appropriate for postmenopausal women with a diagnosed HSDD, wrote the task force, which also noted that libido and response improvements don’t necessarily correlate with testosterone serum levels. If there’s no clinical response after a 6-month trial, the hormone should be discontinued.
The hormone-health connection is clearly important to women, and many have already done Internet research on the topic, said Dr. Margery Gass, executive director of the North American Menopause Society. A Google query for “hormones to control aging” turned up 9.5 million results, she said.
Although NAMS was not involved in creating the new clinical guideline, the society supports it, she said in an interview.
“The Endocrine Society has published an excellent set of guidelines on the use of androgen therapy in women. These guidelines are in harmony with NAMS’ comments on the use of testosterone and dehydroepiandrosterones,” included in the group’s clinical practice guideline for the care of midlife women (Menopause 2014;21:1038-62). That paper also recommends a trial of testosterone therapy “in carefully selected postmenopausal women with female sexual interest/arousal disorder and no other etiology for their sexual problems.”
Dr. Gass continued, “I encourage clinicians to use both publications to help women understand the misinformation about testosterone and other androgens that they are seeing on the Internet.”
Dr. Wierman, chief of endocrinology at the University of Colorado, Aurora, led the task force, composed of representatives from the American Society for Reproductive Medicine, the American Congress of Obstetricians and Gynecologists, the European Society of Endocrinology, and the International Menopause Society. Together, they reviewed the extant literature and, in addition, commissioned meta-analyses to examine the issue of androgen supplementation in premenopausal and postmenopausal women – either healthy or with specific conditions. Evidence was graded as level 1 (strong) or level 2 (weak).
The group considered androgen supplementation for a number of indications: infertility; sexual dysfunction; cognition; cardiovascular, metabolic, and bone health; and general well-being. It found little strong data to support the practice in any of these except HSDD.
As a basic tenet, the task force agreed that androgen testing for most women is inaccurate, and thus virtually incapable of providing useful diagnostic information. Testosterone levels vary among women and within their different hormonal life stages, and there are no validated reference ranges.
Sexual function
A controversial issue, women’s sexual health remains somewhat of a mystery, the team noted – a complex web of physical, emotional, and psychological factors. Evidence derived from testosterone therapy in postmenopausal women shows that the hormone may influence all aspects of sexual response by improving desire, subjective arousal, and vaginal blood flow, and increasing frequency of orgasm.
However, decreasing sexuality is a common phenomenon for women, and is not dependent on physiologic testosterone levels. While response to testosterone therapy didn’t always correlate with plasma levels, most trials found that a daily dose of 300 mcg provided optimal benefit. One study found a more than 115% increase in reported orgasms, compared with a 38% increase in the placebo group, and another found 2.12 more satisfactory sexual events per month, compared with 0.73 per month with placebo.
One trial of a testosterone gel was negative, but was only available as an abstract. A large randomized trial of transdermal testosterone gel that recruited 3,565 naturally and surgically postmenopausal women, and accrued several thousand women-years of data, has yet to be published.
For postmenopausal women with properly diagnosed HSDD, the task force recommended a 3- to 6-month trial of testosterone for those who request therapy and in whom it is not contraindicated.
Testosterone levels should be measured at baseline and after 3-6 weeks of initial treatment to assess patient overuse. In cases of ongoing testosterone therapy, levels should be reviewed every 6 months to monitor for excessive use and signs of androgen excess.
Other indications
The task force noted insufficient evidence for the following indications:
• Infertility. One meta-analysis reported an overall 11% increase in live births; another found no benefit. The individual studies were marred by methodological issues, the team said.
• Bone. Several small studies showed increased bone density in some locations after testosterone therapy. However, many women received concomitant estrogens, so the studies were confounded, the team noted.
• Cognition. Several studies have hinted that testosterone may be protective against Alzheimer’s and other dementias in women, possibly by mediating the accumulation of neurotoxic amyloid beta brain plaques. Women taking the hormone scored better on cognitive tests, including verbal memory, as well as spatial and mathematical reasoning. “In addition to having neuroprotective effects, testosterone has positive effects on endothelial function and acts as a vasodilator, providing another potential pathway through which testosterone may confer neuroprotection,” the investigators said. Again, however, they felt that the body and quality of evidence were not enough to justify a recommendation.
• Cardiovascular. Higher endogenous testosterone in women has been associated with better endothelial function and lower carotid intima-medial thickness; exogenous testosterone has not been adequately studied. However, testosterone supplementation does not seem to negatively affect lipids or increase other cardiovascular risk markers.
• Body composition. Several large studies of women with testosterone-alone and testosterone-estradiol therapy found increased lean muscle mass and lower body fat mass. These results were seen in healthy women as well as those with Turner syndrome, anorexia nervosa, and HIV infections. “Thus,” the investigators concluded, “testosterone increases lean body mass and may decrease fat mass in women, but effects are less dramatic than in men.”
• Mood. Testosterone therapy resulted in improved mood and lower depression scores in several studies, but subjects in some were not screened for comorbidities, including sexual dysfunction.
• Side effects. The potential for masculinizing effects – acne, hirsutism, deepening of the voice, and androgenic alopecia – exists. They are dose dependent, uncommon, and short-lived once supraphysiologic levels are decreased. Findings on breast cancer risk are contradictory; the team said more study is necessary.
The task force commissioned a testosterone therapy meta-analysis of published randomized trials of testosterone-alone or in addition to hormone replacement therapy. “Across all trials, testosterone use was associated with a statistically significant improvement in satisfaction, pleasure, orgasm, and libido. The quality of evidence was moderate to high for pleasure and orgasm outcomes, and moderate for satisfaction and libido outcomes,” with minimal effect on lipids and none on hair growth or loss.
“However,” the task force wrote, “data on adverse effects were not extensive, particularly for long-term use,” with a follow-up of 6 weeks to 2 years.
Dr. Wierman had no financial disclosures. However, several coauthors had numerous disclosures, including financial ties with pharmaceutical companies.
On Twitter @alz_gal
Testosterone supplementation is not recommended for women, unless they have a clinical diagnosis of hypoactive sexual desire disorder, a joint task force led by the Endocrine Society has determined.
While a number of studies have shown that testosterone supplementation helps improve sexual desire, cognition, and other outcomes, most are either too small, too short, or confounded by other factors to provide irrefutable evidence of the hormone’s benefit for any indication other than hypoactive sexual desire disorder (HSDD), Dr. Margaret E. Wierman and her colleagues wrote in the Journal of Clinical Endocrinology and Metabolism (J. Clin. Endocrinol. Metab. 2014;99:3489-510).
A trial of testosterone is only appropriate for postmenopausal women with a diagnosed HSDD, wrote the task force, which also noted that libido and response improvements don’t necessarily correlate with testosterone serum levels. If there’s no clinical response after a 6-month trial, the hormone should be discontinued.
The hormone-health connection is clearly important to women, and many have already done Internet research on the topic, said Dr. Margery Gass, executive director of the North American Menopause Society. A Google query for “hormones to control aging” turned up 9.5 million results, she said.
Although NAMS was not involved in creating the new clinical guideline, the society supports it, she said in an interview.
“The Endocrine Society has published an excellent set of guidelines on the use of androgen therapy in women. These guidelines are in harmony with NAMS’ comments on the use of testosterone and dehydroepiandrosterones,” included in the group’s clinical practice guideline for the care of midlife women (Menopause 2014;21:1038-62). That paper also recommends a trial of testosterone therapy “in carefully selected postmenopausal women with female sexual interest/arousal disorder and no other etiology for their sexual problems.”
Dr. Gass continued, “I encourage clinicians to use both publications to help women understand the misinformation about testosterone and other androgens that they are seeing on the Internet.”
Dr. Wierman, chief of endocrinology at the University of Colorado, Aurora, led the task force, composed of representatives from the American Society for Reproductive Medicine, the American Congress of Obstetricians and Gynecologists, the European Society of Endocrinology, and the International Menopause Society. Together, they reviewed the extant literature and, in addition, commissioned meta-analyses to examine the issue of androgen supplementation in premenopausal and postmenopausal women – either healthy or with specific conditions. Evidence was graded as level 1 (strong) or level 2 (weak).
The group considered androgen supplementation for a number of indications: infertility; sexual dysfunction; cognition; cardiovascular, metabolic, and bone health; and general well-being. It found little strong data to support the practice in any of these except HSDD.
As a basic tenet, the task force agreed that androgen testing for most women is inaccurate, and thus virtually incapable of providing useful diagnostic information. Testosterone levels vary among women and within their different hormonal life stages, and there are no validated reference ranges.
Sexual function
A controversial issue, women’s sexual health remains somewhat of a mystery, the team noted – a complex web of physical, emotional, and psychological factors. Evidence derived from testosterone therapy in postmenopausal women shows that the hormone may influence all aspects of sexual response by improving desire, subjective arousal, and vaginal blood flow, and increasing frequency of orgasm.
However, decreasing sexuality is a common phenomenon for women, and is not dependent on physiologic testosterone levels. While response to testosterone therapy didn’t always correlate with plasma levels, most trials found that a daily dose of 300 mcg provided optimal benefit. One study found a more than 115% increase in reported orgasms, compared with a 38% increase in the placebo group, and another found 2.12 more satisfactory sexual events per month, compared with 0.73 per month with placebo.
One trial of a testosterone gel was negative, but was only available as an abstract. A large randomized trial of transdermal testosterone gel that recruited 3,565 naturally and surgically postmenopausal women, and accrued several thousand women-years of data, has yet to be published.
For postmenopausal women with properly diagnosed HSDD, the task force recommended a 3- to 6-month trial of testosterone for those who request therapy and in whom it is not contraindicated.
Testosterone levels should be measured at baseline and after 3-6 weeks of initial treatment to assess patient overuse. In cases of ongoing testosterone therapy, levels should be reviewed every 6 months to monitor for excessive use and signs of androgen excess.
Other indications
The task force noted insufficient evidence for the following indications:
• Infertility. One meta-analysis reported an overall 11% increase in live births; another found no benefit. The individual studies were marred by methodological issues, the team said.
• Bone. Several small studies showed increased bone density in some locations after testosterone therapy. However, many women received concomitant estrogens, so the studies were confounded, the team noted.
• Cognition. Several studies have hinted that testosterone may be protective against Alzheimer’s and other dementias in women, possibly by mediating the accumulation of neurotoxic amyloid beta brain plaques. Women taking the hormone scored better on cognitive tests, including verbal memory, as well as spatial and mathematical reasoning. “In addition to having neuroprotective effects, testosterone has positive effects on endothelial function and acts as a vasodilator, providing another potential pathway through which testosterone may confer neuroprotection,” the investigators said. Again, however, they felt that the body and quality of evidence were not enough to justify a recommendation.
• Cardiovascular. Higher endogenous testosterone in women has been associated with better endothelial function and lower carotid intima-medial thickness; exogenous testosterone has not been adequately studied. However, testosterone supplementation does not seem to negatively affect lipids or increase other cardiovascular risk markers.
• Body composition. Several large studies of women with testosterone-alone and testosterone-estradiol therapy found increased lean muscle mass and lower body fat mass. These results were seen in healthy women as well as those with Turner syndrome, anorexia nervosa, and HIV infections. “Thus,” the investigators concluded, “testosterone increases lean body mass and may decrease fat mass in women, but effects are less dramatic than in men.”
• Mood. Testosterone therapy resulted in improved mood and lower depression scores in several studies, but subjects in some were not screened for comorbidities, including sexual dysfunction.
• Side effects. The potential for masculinizing effects – acne, hirsutism, deepening of the voice, and androgenic alopecia – exists. They are dose dependent, uncommon, and short-lived once supraphysiologic levels are decreased. Findings on breast cancer risk are contradictory; the team said more study is necessary.
The task force commissioned a testosterone therapy meta-analysis of published randomized trials of testosterone-alone or in addition to hormone replacement therapy. “Across all trials, testosterone use was associated with a statistically significant improvement in satisfaction, pleasure, orgasm, and libido. The quality of evidence was moderate to high for pleasure and orgasm outcomes, and moderate for satisfaction and libido outcomes,” with minimal effect on lipids and none on hair growth or loss.
“However,” the task force wrote, “data on adverse effects were not extensive, particularly for long-term use,” with a follow-up of 6 weeks to 2 years.
Dr. Wierman had no financial disclosures. However, several coauthors had numerous disclosures, including financial ties with pharmaceutical companies.
On Twitter @alz_gal
Testosterone supplementation is not recommended for women, unless they have a clinical diagnosis of hypoactive sexual desire disorder, a joint task force led by the Endocrine Society has determined.
While a number of studies have shown that testosterone supplementation helps improve sexual desire, cognition, and other outcomes, most are either too small, too short, or confounded by other factors to provide irrefutable evidence of the hormone’s benefit for any indication other than hypoactive sexual desire disorder (HSDD), Dr. Margaret E. Wierman and her colleagues wrote in the Journal of Clinical Endocrinology and Metabolism (J. Clin. Endocrinol. Metab. 2014;99:3489-510).
A trial of testosterone is only appropriate for postmenopausal women with a diagnosed HSDD, wrote the task force, which also noted that libido and response improvements don’t necessarily correlate with testosterone serum levels. If there’s no clinical response after a 6-month trial, the hormone should be discontinued.
The hormone-health connection is clearly important to women, and many have already done Internet research on the topic, said Dr. Margery Gass, executive director of the North American Menopause Society. A Google query for “hormones to control aging” turned up 9.5 million results, she said.
Although NAMS was not involved in creating the new clinical guideline, the society supports it, she said in an interview.
“The Endocrine Society has published an excellent set of guidelines on the use of androgen therapy in women. These guidelines are in harmony with NAMS’ comments on the use of testosterone and dehydroepiandrosterones,” included in the group’s clinical practice guideline for the care of midlife women (Menopause 2014;21:1038-62). That paper also recommends a trial of testosterone therapy “in carefully selected postmenopausal women with female sexual interest/arousal disorder and no other etiology for their sexual problems.”
Dr. Gass continued, “I encourage clinicians to use both publications to help women understand the misinformation about testosterone and other androgens that they are seeing on the Internet.”
Dr. Wierman, chief of endocrinology at the University of Colorado, Aurora, led the task force, composed of representatives from the American Society for Reproductive Medicine, the American Congress of Obstetricians and Gynecologists, the European Society of Endocrinology, and the International Menopause Society. Together, they reviewed the extant literature and, in addition, commissioned meta-analyses to examine the issue of androgen supplementation in premenopausal and postmenopausal women – either healthy or with specific conditions. Evidence was graded as level 1 (strong) or level 2 (weak).
The group considered androgen supplementation for a number of indications: infertility; sexual dysfunction; cognition; cardiovascular, metabolic, and bone health; and general well-being. It found little strong data to support the practice in any of these except HSDD.
As a basic tenet, the task force agreed that androgen testing for most women is inaccurate, and thus virtually incapable of providing useful diagnostic information. Testosterone levels vary among women and within their different hormonal life stages, and there are no validated reference ranges.
Sexual function
A controversial issue, women’s sexual health remains somewhat of a mystery, the team noted – a complex web of physical, emotional, and psychological factors. Evidence derived from testosterone therapy in postmenopausal women shows that the hormone may influence all aspects of sexual response by improving desire, subjective arousal, and vaginal blood flow, and increasing frequency of orgasm.
However, decreasing sexuality is a common phenomenon for women, and is not dependent on physiologic testosterone levels. While response to testosterone therapy didn’t always correlate with plasma levels, most trials found that a daily dose of 300 mcg provided optimal benefit. One study found a more than 115% increase in reported orgasms, compared with a 38% increase in the placebo group, and another found 2.12 more satisfactory sexual events per month, compared with 0.73 per month with placebo.
One trial of a testosterone gel was negative, but was only available as an abstract. A large randomized trial of transdermal testosterone gel that recruited 3,565 naturally and surgically postmenopausal women, and accrued several thousand women-years of data, has yet to be published.
For postmenopausal women with properly diagnosed HSDD, the task force recommended a 3- to 6-month trial of testosterone for those who request therapy and in whom it is not contraindicated.
Testosterone levels should be measured at baseline and after 3-6 weeks of initial treatment to assess patient overuse. In cases of ongoing testosterone therapy, levels should be reviewed every 6 months to monitor for excessive use and signs of androgen excess.
Other indications
The task force noted insufficient evidence for the following indications:
• Infertility. One meta-analysis reported an overall 11% increase in live births; another found no benefit. The individual studies were marred by methodological issues, the team said.
• Bone. Several small studies showed increased bone density in some locations after testosterone therapy. However, many women received concomitant estrogens, so the studies were confounded, the team noted.
• Cognition. Several studies have hinted that testosterone may be protective against Alzheimer’s and other dementias in women, possibly by mediating the accumulation of neurotoxic amyloid beta brain plaques. Women taking the hormone scored better on cognitive tests, including verbal memory, as well as spatial and mathematical reasoning. “In addition to having neuroprotective effects, testosterone has positive effects on endothelial function and acts as a vasodilator, providing another potential pathway through which testosterone may confer neuroprotection,” the investigators said. Again, however, they felt that the body and quality of evidence were not enough to justify a recommendation.
• Cardiovascular. Higher endogenous testosterone in women has been associated with better endothelial function and lower carotid intima-medial thickness; exogenous testosterone has not been adequately studied. However, testosterone supplementation does not seem to negatively affect lipids or increase other cardiovascular risk markers.
• Body composition. Several large studies of women with testosterone-alone and testosterone-estradiol therapy found increased lean muscle mass and lower body fat mass. These results were seen in healthy women as well as those with Turner syndrome, anorexia nervosa, and HIV infections. “Thus,” the investigators concluded, “testosterone increases lean body mass and may decrease fat mass in women, but effects are less dramatic than in men.”
• Mood. Testosterone therapy resulted in improved mood and lower depression scores in several studies, but subjects in some were not screened for comorbidities, including sexual dysfunction.
• Side effects. The potential for masculinizing effects – acne, hirsutism, deepening of the voice, and androgenic alopecia – exists. They are dose dependent, uncommon, and short-lived once supraphysiologic levels are decreased. Findings on breast cancer risk are contradictory; the team said more study is necessary.
The task force commissioned a testosterone therapy meta-analysis of published randomized trials of testosterone-alone or in addition to hormone replacement therapy. “Across all trials, testosterone use was associated with a statistically significant improvement in satisfaction, pleasure, orgasm, and libido. The quality of evidence was moderate to high for pleasure and orgasm outcomes, and moderate for satisfaction and libido outcomes,” with minimal effect on lipids and none on hair growth or loss.
“However,” the task force wrote, “data on adverse effects were not extensive, particularly for long-term use,” with a follow-up of 6 weeks to 2 years.
Dr. Wierman had no financial disclosures. However, several coauthors had numerous disclosures, including financial ties with pharmaceutical companies.
On Twitter @alz_gal
