International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women.
Level 5 - mechanism / opinion, no new human data
Expert consensus clinical practice guideline developed via modified Delphi method
PubMed 33814355 · doi:10.1016/j.jsxm.2020.10.009
What was done
An expert multidisciplinary panel appointed by the International Society for the Study of Women's Sexual Health (ISSWSH) conducted a literature review of original research, meta-analyses, reviews, and consensus guidelines on testosterone therapy in women. The panel used a modified Delphi method to establish consensus recommendations on patient selection, laboratory testing, dosing, monitoring, and follow-up care for women with hypoactive sexual desire disorder (HSDD).
What was found
The abstract reports no numerical data or effect sizes. Key qualitative consensus points include: - Systemic transdermal testosterone provides moderate therapeutic benefit for women with HSDD not primarily caused by modifiable factors or comorbidities. - Evidence supports use primarily in postmenopausal women, with limited data supporting use in late reproductive age premenopausal women. - Physiologic testosterone therapy shows no serious adverse events, but long-term safety data are not established. - Serum total testosterone should be used as a baseline for safety monitoring rather than as a diagnostic tool. - Government-approved male transdermal formulations may be used cautiously with female-appropriate dosing; compounded formulations are not recommended due to lack of safety and efficacy data.
Why it matters
This guideline provides clinicians with structured protocols for off-label prescribing, dosing, and safety monitoring of transdermal testosterone in women with HSDD, addressing a clinical care gap caused by the lack of approved female formulations in most jurisdictions.
Limits
The abstract reports no quantitative outcome data, effect estimates, or panel consensus percentages. Regulatory approval for female testosterone therapy remains largely absent, complicating standardized dosing. Long-term safety is not established.
Cited by
- supports Testosterone therapy in women is currently only scientifically proven to be effective for treating low sexual desire and low libido.
- supports Testosterone supplementation above low-normal physiological levels in women can cause side effects including voice deepening and unwanted hair growth.