The Safety of Testosterone Therapy in Women

The document from 2012 reviews the safety of testosterone therapy in women, particularly for those with hypoactive sexual desire disorder (HSDD). It discusses potential side effects and risks, including hirsutism, acne, behavioral changes, and the risks of breast and endometrial cancer. The APHRODITE trial with 814 women showed that low doses of transdermal testosterone may cause mild androgenic side effects but did not significantly affect acne or voice deepening, and improved mood and well-being. Studies did not show significant risks for breast cancer, and testosterone might counteract estrogen-induced breast cell proliferation. Testosterone alone did not alter endometrial thickness or proliferation, and danazol, a testosterone derivative, reversed endometrial growth in hyperplasia. The review also covers testosterone's effects on endometrial health, hepatotoxicity, cardiovascular health, lipid profiles, plasma viscosity, coagulation, hemoglobin levels, blood pressure, vascular reactivity, insulin resistance, and bone health. The Rancho Bernardo Study of 639 postmenopausal women suggested an optimal range of serum testosterone for cardiovascular health. Transdermal testosterone did not show hepatotoxic side effects or significantly impact HDL cholesterol levels, plasma viscosity, coagulation, hemoglobin levels, blood pressure, or insulin resistance, and it increased bone mineral density. A long-term study of 8412 women with a mean age of 47 and an average follow-up of 4.4 years found no significant differences in disease rates between those on testosterone therapy and those on placebo. The document concludes that short-term testosterone therapy appears safe for postmenopausal women with HSDD when administered transdermally at doses of 150 µg or 300 µg per day, but more long-term studies are needed.