Use Of Testosterone Therapy By Postmenopausal Women: Position Statement
Of The North American Menopause Society
CLEVELAND (September 8, 2005): Testosterone
therapy has been shown to improve sexual function in many postmenopausal women,
primarily the symptoms of sexual desire, arousal, and orgasmic response, according
to the most recent evidence-based Position Statement from The North American
Menopause Society (NAMS). The paper, titled "The role of testosterone in postmenopausal
women," is published in the September/October 2005 issue of the Society's
official journal, Menopause.
"NAMS developed this Position Statement
to fulfill a need for practical clinical guidelines on the use of testosterone
to treat postmenopausal women," said Wulf H. Utian, MD, PhD, NAMS Executive
Director. "This paper provides a valuable source of information regarding
the physiology of testosterone, its use in clinical trials, patient evaluation,
side effects, monitoring while on therapy, and the differences in available
Based on clinical trial evidence, postmenopausal women who report decreased
sexual desire may be candidates for testosterone therapy, but they should
first be evaluated for other causes of their sexual concerns and should be
more appropriately treated with alternative approaches. Conditions that can
decrease sexual desire include psychosocial issues (such as stress, fatigue,
or relationship conflict), psychological disorders (including depression or
anxiety), medical conditions (such as vaginal atrophy or hypothyroidism),
and drug use (including antidepressants and alcohol).
"The only current indication for testosterone therapy in postmenopausal women
is to treat sexual concerns, primarily decreased sexual desire," said Jan
L. Shifren, MD, Chair of the Editorial Board for this Position Statement.
"No other use is supported by the scientific literature, including increasing
lean body mass, reducing hot flashes, or improving bone density." Dr. Shifren
is Assistant Professor of Obstetrics, Gynecology and Reproductive Biology,
Harvard Medical School, and Director, Menopause Program, Vincent Obstetrics
and Gynecology Service, Massachusetts General Hospital, Boston.
Even though testosterone is an effective treatment for decreased sexual function,
low testosterone levels have not been clearly linked to sexual function in
Both oral and non-oral (eg, patches, creams, gels) testosterone products have
been used in clinical trials. However, essentially no products are government-approved
in the United States or Canada for treating sexual dysfunction in women. Therefore,
healthcare providers recommend prescription testosterone products intended
for other indications in women or products developed for men. Some providers
prescribe custom-compounded products.
"Because of the lack of approved products for women, healthcare practitioners
recommend products for uses or at doses that have not been rigorously tested
in women," Dr. Shifren said. "Women need to know that we have limited information
on the risks and benefits of these formulations."
The most common side effects associated with testosterone therapy are facial
hair growth and acne. If adverse events are observed, reducing the dose or
stopping therapy is advised. The risks associated with long-term use in women
The NAMS Position Statement contains the following recommendations regarding
- Transdermal patches or topical gels or creams may be preferred over
oral products, but only oral and intramuscular (injection) testosterone
products for women are currently government-approved.
- Products formulated specifically for men provide excessive doses for
women and should not be used unless doses are reduced considerably and blood
testosterone levels are monitored closely for excessive levels.
- Testosterone therapy should be administered at the lowest dose for
the shortest time that meets treatment goals.
- Laboratory testing of testosterone levels should be used only to monitor
for supraphysiologic testosterone levels before and during therapy, not
to diagnose testosterone insufficiency; laboratory tests cannot accurately
detect testosterone concentrations at the low values typically found in
NAMS is North America's leading nonprofit
organization dedicated to promoting women's health and quality of life through
an understanding of menopause. The Society's membership of more than 2,000
includes experts from medicine, nursing, sociology, psychology, pharmacy,
anthropology, epidemiology, nutrition, education, and basic science - helping
NAMS to be the preeminent resource on all aspects of menopause to healthcare
providers and the public. NAMS acknowledges that the development of this
position statement was supported by an unrestricted educational grant from
Procter & Gamble Pharmaceuticals.
Created: 9/8/2005  - Donnica Moore, M.D.