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Glenn D. Braunstein, The Endocrine Society Clinical Practice Guideline and The North American Menopause Society Position Statement on Androgen Therapy in Women: Another One of Yogi’s Forks, The Journal of Clinical Endocrinology & Metabolism, Volume 92, Issue 11, 1 November 2007, Pages 4091–4093, https://doi.org/10.1210/jc.2007-1709
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“When you come to a fork in the road, take it.”
—Yogi Berra
Clinicians are faced with a therapeutic dilemma resulting from the publication of two guidelines/position statements regarding the use of testosterone for menopausal women from two respected societies: The Endocrine Society and the North American Menopause Society (NAMS) (1, 2). The authors of both of these scholarly works are highly accomplished academic clinician-scientists who carefully analyzed the data that were available using an evidence-based approach.
As would be expected, there was much upon which they agreed including the data concerning the physiology of androgen production in women, the fact that most assays that are used to measure total and free testosterone in women are neither accurate nor precise, and that reliable, age-matched normative data that can be used clinically are, at best, sparse (see The Endocrine Society’s more recent position statement on testosterone measurements for additional detail) (3). They agree that despite these limitations, there are several conditions that have been shown to be associated with low testosterone levels in women. These include surgical menopause, hypopituitarism, adrenal insufficiency, systemic glucocorticoid or oral estrogen therapy, and chronic illness. They further agree that there is no clear association between circulating levels of testosterone and sexual function. Both acknowledge that the administration of testosterone to surgically menopausal women receiving concomitant estrogen therapy who had developed distressing loss of sexual desire after their oophorectomy is efficacious in improving libido and an increasing the number of satisfying sexual events. This significant improvement in sexual function occurred with doses of testosterone that raised the serum free testosterone levels to within the normal range for premenopausal women. Agreement was also present concerning the dearth of high-quality data and conflicting information surrounding androgen treatment effects on cognition, mood, bone, cardiovascular function, and body composition. Finally, both groups point out that long-term (>6 months) safety data under controlled circumstances are unknown and that data concerning efficacy and safety in postmenopausal women who are not receiving estrogens were unknown at the time that the papers were submitted to the journals.
