Androgen Therapy in Women with Testosterone Insufficiency: Looking Back and Looking Ahead

Abstract

In women, androgens not only serve as precursors for biosynthesis of estrogens but also exert a critical physiological role in sexual function, bone health, mood, behavior, and cognition. Despite research in the 1940s establishing the physiological role of testosterone (T) in women's health and the substantial benefits of T therapy (TTh) in women, the use of TTh in women today is rare, with little awareness of its value and safety within the medical community. We have identified several factors that have contributed to this situation, including: The rationale and use of androgens in women is not taught in medical schools; residual fear from the Women's Health Initiative study that sex hormones are associated with increased breast cancer risk; and absence of regulatory-approved T products for women in most parts of the world, except Australia. Although concerns regarding the efficacy and safety of TTh in women with sexual dysfunction have been appropriately addressed in randomized, placebo-controlled, studies TTh in women is prescribed by only a small percentage of physicians, and women who choose this treatment must use products intended for men as off-label treatment or find products via compounding pharmacies. Looking forward, we envision the possibility within the near future of symptomatic women with T insufficiency finding sympathetic health care providers who will recognize and appropriately treat their condition without negative judgment, allowing these women to experience the health and well-being associated with robust T levels. For this vision to occur, it will require education in medical school and postgraduate training, and broader acceptance of the science of TTh in women, noting its benefits and excellent safety profile.