Testosterone is made in small amounts by women's ovaries and adrenal glands. Its use in women is off-label in most countries, because no product is approved for women. The question is narrow: which women, which route and which dose the trials actually tested.
What the pooled trials measured
Islam and colleagues pooled 36 randomized trials with 8,480 women, each at least 12 weeks long. Testosterone raised sexual desire against placebo (standardized mean difference 0.36, 95% CI 0.22 to 0.50), increased arousal (0.28) and reduced sexual distress (-0.27). These are small-to-moderate standardized effects, and the trials were not designed to measure heart or cancer outcomes.
Route and lipids
The pooled analysis reported that oral testosterone raised LDL cholesterol and lowered total cholesterol, HDL and triglycerides in the trials that tested it, and that non-oral routes, such as transdermal forms, did not show those lipid changes. Overall weight rose in the pooled trials.
The trial without estrogen
APHRODITE randomized 814 postmenopausal women with hypoactive sexual desire disorder who were not using estrogen to a transdermal testosterone patch at 150 or 300 micrograms a day, or placebo, for 52 weeks. Sexual function improved with testosterone. Commentators raised concerns about breast and endometrial cancer and called for longer trials.
The 2019 consensus
The Global Consensus Position Statement, from many societies, judged that hypoactive sexual desire disorder is the only condition with enough evidence for testosterone in women. It advises doses that keep blood testosterone near premenopausal physiological levels, and it recommends against compounded testosterone. It states that its dosing advice does not apply to injections, pellets or products that give supraphysiological levels.
What this does not say
- The trials tested approved or trial-specific products at set doses. They do not test compounded creams or cypionate injections.
- Benefits were shown for sexual wellbeing, not for energy, mood, bone or cognition.
- Long-term safety, including breast and endometrial effects, is not established.
How we use this
Our physicians consider testosterone only for the indication the consensus supports, after a full history and a discussion of the unknowns. We keep to doses that aim for premenopausal levels and do not promise a change in desire.
We tell you when a product is compounded and not one of the studied products.
Explore weight loss treatmentsSources
- 1.Islam RM et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol 2019;7:754-766. The Lancet Diabetes & Endocrinology
- 2.Davis SR et al. Testosterone for low libido in postmenopausal women not taking estrogen (APHRODITE). N Engl J Med 2008;359:2005-2017. NEJM
- 3.Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab 2019;104:4660-4666. JCEM
- 4.Wierman ME et al. Androgen therapy in women: a reappraisal. Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2014;99:3489-3510. JCEM