Challenges in the Diagnosis of Testosterone Deficiency in Women and Treatment Options

This article aims to provide a broad overview of the challenges and considerations in managing testosterone deficiency in women, offering an informed basis for clinical practice.

This article aims to provide an overview of the challenges and considerations in managing testosterone deficiency in women, offering an informed basis for clinical practice.

Testosterone deficiency in women is an emerging topic in clinical practice, with significant implications for health and well-being. Although traditionally associated with men, testosterone plays a crucial role in female physiology, influencing libido, energy, muscle mass, and bone density. However, diagnosing and treating this condition in women presents unique challenges.

Challenges in Diagnosis

Non-Specific Symptoms: Symptoms of testosterone deficiency in women, such as fatigue, low libido, depression, and muscle loss, are non-specific and can be confused with other conditions, such as thyroid disorders, menopause, or depression.

Lack of Consensus on Reference Levels: Unlike men, there is no clear consensus on normal testosterone levels in women, complicating diagnosis. Testosterone concentrations in women are naturally low and vary with age and the menstrual cycle, making it difficult to establish a universal cutoff point.

Testing Methods: The accuracy of laboratory tests to measure testosterone in women is limited. Many assays are not sensitive enough to detect low circulating testosterone levels in women. The best options for dosage are mass spectrometry for total testosterone and equilibrium dialysis for free testosterone.

Stigmatization: The cultural perception that testosterone is a “male” hormone can lead to the stigmatization of women with testosterone deficiency, discouraging them from seeking proper diagnosis and treatment. Even today, we see some doctors who do not consider testosterone replacement in their patients.

Treatment Options

Testosterone Replacement: Hormone replacement therapy (TRT) can be administered in various ways, with transdermal gels and subcutaneous implants being the most commonly used options in Brazil. The goal is to physiologically replenish testosterone levels, alleviating symptoms associated with its deficiency.

Lifestyle Modifications: Non-pharmacological interventions, such as resistance exercise, balanced diet, and stress management, can help improve natural testosterone levels and relieve symptoms.

Treatment of Underlying Conditions: It is crucial to identify and treat any underlying condition that may be contributing to testosterone deficiency, such as thyroid disorders.

Evidence and Safety of Testosterone Replacement in Women

Efficacy: Studies show that TRT can significantly improve libido, energy, and well-being in women with testosterone deficiency. However, individual responses to treatment may vary.

Risks and Side Effects: The long-term safety of TRT in women is still being researched. Potential side effects include acne, facial hair growth, and alterations in lipid profiles. While there are concerns about the risk of breast cancer and cardiovascular disease, current evidence does not point to such risks.

Clinical Monitoring: Women on TRT should be monitored regularly to evaluate treatment efficacy and identify any adverse effects. This includes blood tests to monitor hormone levels and periodic clinical evaluations.

Conclusion

The diagnosis and treatment of testosterone deficiency in women are complex and require a careful and personalized approach. While TRT can offer significant benefits, it is essential to consider potential risks and closely monitor patients. Further research is needed to clarify reference levels, long-term safety, and efficacy of interventions, ensuring that women receive the best possible care.

In the refresher courses on hormone therapy with implants at Renewal, we refine the knowledge and provide safety and support for you, the physician, to work with one of the most effective therapies in the world. Join the upcoming classes!

Article written by Dr. Francisco Tostes, Scientific Director at Renewal.

References

• “Hormone Replacement Therapy and the Menopause”
• “Androgens and Androgen Receptor: Mechanisms, Functions, and Clinical Applications”
• Nathorst-Böös, J., et al. (2006). “Quality of Life in Postmenopausal Women on the Long-term Use of Testosterone Therapy: A 5-year Follow-up Study” – Maturitas, 53(3), 253-259.
• Davis, S. R., et al. (2015). “Testosterone for Postmenopausal Women: A Systematic Review and Meta-analysis” – Menopause, 22(8), 872-879.
• Braunstein, G. D. (2007). “Safety of Testosterone Treatment in Postmenopausal Women” – Fertility and Sterility, 88(1), 1-17.