Androgen Therapy for women

Question 1

Androgen Therapy for women:

Testosterone does what?

Answer 1

Ovarian follicle development
Bone and muscle health
Vascular endothelial function
Libido

Question 2

Androgen Therapy for women:

Secretion?

Answer 2

Adrenal glands
-Dehydroepiandrosterone (DHEA)
-Androstenedione
These are precursors that are converted in peripheral tissues to testosterone and dihydrotesterone (DHT) *the most potent androgen

Question 3

Androgen Therapy for women:

Testing?

Answer 3

Free testosterone

• is calculated by many different equations so is inconsistent*
• Not to be used for diagnosis**

Testosterone level (via immunoassay)

• lacks precision at low levels (not to be used for diagnosing low testosterone)
• used for high/high normal level identification (in which case therapy is not required)

No cut-off level of any androgen measurement can determine if a woman has sexual dysfunction

Question 4

Androgen Therapy for women:

Approach to sexual problems and testosterone therapy?

Answer 4

Context:

• lifelong vs acquired
• generalised vs situational

psychological, sexual, physical abuse history

• relationship issues
• knowledge and belief about sexuality

IF modifiable and potential contributing factors have been addressed then MAYBE testosterone therapy trial is indicated

Transdermal preparations only (other formulations lack evidence of efficacy and safety and may expose women to supraphysiological levels)

Question 5

Androgen Therapy for women:

How to monitor therapy?

Answer 5

Baseline SHBG levels and total testosterone levels

• repeat 3 -6 weeks after initiation
• 6 monthly thereafter

Testosterone immunoassay result that is ≥50% ULN requires reduction of testosterone therapy dose

Can take 4 -8 weeks for response

Discontinue if no response after 6 months

Question 6

Androgen Therapy for women:

Safety and Efficacy?

Answer 6

Benefits over placebo include:

increased frequency of satisfying:

• sexual experiences
• sexual desire
• arousal
• orgasm
• responsiveness
• self image

Sparse data for premenopausal women or those with Hypoactive Sexual Desire Disorder/Dysfunction (HSDD).

Side Effects:

• from trials of postmenopausal women*
• body/facial hair growth
• acne

Not used in women with high CVD risks.