Androgen therapy in women: An Endocrine Society clinical practice guideline
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OBJECTIVE: The objective was to provide guidelines for the therapeutic use of androgens in women. PARTICIPANTS: The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, six additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. EVIDENCE: The Task Force used systematic reviews of available evidence to inform its key recommendations. The Task Force used consistent language and graphical descriptions of both the strength of recommendation and the quality of evidence, using the recommendations of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) group. The strength of a recommendation is indicated by the number 1 (strong recommendation, associated with the phrase "we recommend") or 2 (weak recommendation, associated with the phrase "we suggest"). The quality of the evidence is indicated by cross-filled circles, such that [1 cross-filled circle, 3 empty circles] denotes very-low-quality evidence, [2 cross-filled circles, 2 empty circles] low quality, [3 cross-filled circles, 1 empty circle] moderate quality, and [4 cross-filled circles] high quality. Each recommendation is followed by a description of the evidence. CONSENSUS PROCESS: Consensus was guided by systematic reviews of evidence and discussions during one group meeting, several conference calls, and e-mail communications. The drafts prepared by the task force with the help of a medical writer were reviewed successively by The Endocrine Society's CGS, Clinical Affairs Committee (CAC), and Executive Committee. The version approved by the CGS and CAC was placed on The Endocrine Society's web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes. CONCLUSIONS: We recommend against making a diagnosis of androgen deficiency in women at present because of the lack of a well-defined clinical syndrome and normative data on total or free testosterone levels across the lifespan that can be used to define the disorder. Although there is evidence for short-term efficacy of testosterone in selected populations, such as surgically menopausal women, we recommend against the generalized use of testosterone by women because the indications are inadequate and evidence of safety in long-term studies is lacking. A review of the data currently available is presented, and areas of future research are outlined. To formulate clinical guidelines for use of testosterone in women, additional information will be necessary. This includes defining conditions that, when not treated with androgens, have adverse health consequences to women; defining clinical and laboratory parameters that distinguish those with these conditions; and assessing the efficacy and long-term safety of androgen administration on outcomes that are important to women diagnosed with these conditions. This necessary clinical research cannot occur until the biological, physiological, and psychological underpinnings of the role of androgens in women and candidate disorders are further elucidated.
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There is currently no consensus on accepted lower testosterone limits or established reference intervals.
“Currently, there is no consensus as to the accepted lower T limits or established reference intervals.”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [93]
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Self-citation
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“T1 ( 38 ) 529 15,713 28 2.79 (1.81–4.31) 0.0001 2.89 (1.86–4.48) 0.0001”
InfluentialMartin, K. A., Chang, R. J., Ehrmann, D. A., Ibáñez, L., Løbo, R. A., Rosenfield, R. L., Shapiro, J., Montori, V. M., & Swiglo, B. A. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-2437 · Cited by 506 · see citing works
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“Further, androgen deficiency in women is not well-defined and thus should not be diagnosed until normative data on testosterone levels across a woman’s lifespan have been established (17).”
BackgroundTestosterone for Low Libido in Postmenopausal Women Not Taking Estrogen
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“Subsequent to our 2006 guideline (5), an additional clinical study used mass spectrometry-based methods to measure Table 1.”
MethodInfluentialSelf-citationA Mindfulness-Based Group Psychoeducational Intervention Targeting Sexual Arousal Disorder in Women
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“In addition to progesterone, androgen levels also decrease during the menopausal transition((85)) and could contribute to bone loss.”
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“In particular, immunoassays are affected by cross-reactivity with other steroids (Middle, 2007; Benton et al., 2011) and by high levels of SHBG (Masters and Hahnel, 1989; Wierman et al., 2006).”
BackgroundSexual dysfunction in men and women with endocrine disorders
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“In addition to progesterone, androgen levels also decrease during the menopausal transition (34) and could contribute to bone loss.”
BackgroundSelf-citationWomen’s Sexual Desire and Arousal Disorders
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“Women with elevated androgen levels, whether endogenous or exogenous, experience breast atro phy consistent with the notion that androgens, per se, are anti-proliferative for the breast (Wierman et al., 2006).”
BackgroundLong-term risk of depressive and anxiety symptoms after early bilateral oophorectomy
Rocca, W. A., Grossardt, B. R., Geda, Y. E., Gostout, B. S., Bower, J. H., Maraganore, D. M., de Andrade, M., & Melton, L. J. (2018) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000001229 · Cited by 169 · see citing works
Traceability in Laboratory Medicine
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Involvement of androgens in ovarian health and disease
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“…in 2006 recommend against making a diagnosis of androgen deficiency in women with normal adrenal function because of the lack of a clearly defined clinical syndrome, and of normative data on testosterone levels across women’s lifespan that can be used to define the disorder (Wierman et al., 2006).”
Breast cancer in young women and its impact on reproductive function
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“women (Wierman et al., 2006) or after breast cancer (Barton et al.”
Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy
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“However, the effect of progesterone and testosterone on psychiatric symptoms in women remains uncertain.(28,29) Third, the association between oophorectomy and increased risk of depressive or anxiety symptoms may be due to one or several susceptibility genes that increase the risk of both outcomes independently (ie, c…”
BackgroundVesper, H. W., Bhasin, S., Wang, C., Tai, S. S., Dodge, L. A., Singh, R. J., Nelson, J., Ohorodnik, S., Clarke, N. J., Salameh, W. A., et al. (2009) · Steroids · doi:10.1016/j.steroids.2009.01.004 · Cited by 152 · see citing works
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“significantly under-researched, as recently acknowledged by a task force of The Endocrine Society [148].”
BackgroundKlein, C., & Gorzalka, B. B. (2009) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2009.01370.x · Cited by 144 · see citing works
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“The hypothesis of a neuroprotective effect of progesterone and testosterone is corroborated by several laboratory and clinical studies [23,25,26,44,51,52].”
ResultRevisiting the role of testosterone: Are we missing something?
Tyagi, V., Scordo, M., Yoon, R. S., Liporace, F. A., & Greene, L. W. (2017) · PubMed Central · doi:10.3909/riu0716 · Cited by 137 · see citing works
The Roles of Androgens in Humans: Biology, Metabolic Regulation and Health
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Opioid-Induced Androgen Deficiency (OPIAD)
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Androgen synthesis in adrenarche
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“Some clinical studies suggest that DHEA may have some activity on mood and behavior [137, 138], but this remains controversial [139] and DHEA replacement therapy is not yet standard-of-care [140].”
BackgroundEndocrine Aspects of Women’s Sexual Function
Wierman, M. E., Nappi, R. E., Avis, N. E., Davis, S. R., Labrie, F., Rosner, W., & Shifren, J. L. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2009.01629.x · Cited by 132 · see citing works
Self-citationGooren, L. J., & Giltay, E. J. (2007) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2007.00646.x · Cited by 123 · see citing works
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“the use of androgen therapy in women—for example, between the Endocrine Society clinical practice guidelines (against) [120] and the North American Menopause Neurobiology of Female Sexual Response, and Agents for Treatment of HSDD”
MethodNijland, E. A., Schultz, W. C. M. W., Nathorst‐Böös, J., Helmond, F. A., van Lunsen, R. H. W., Palacios, S., Norman, R. J., Mulder, R. J., Davis, S. R., & Lisa study investigators (2008) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2007.00726.x · Cited by 122 · see citing works
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Self-citationChanges in pituitary function with ageing and implications for patient care
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Standardization of testosterone measurements in humans
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“Testosterone therapy is offered by some clinicians for HSDD but its safety and efficacy have not been well established [120] in healthy women or after breast cancer [121].”
BackgroundSelf-citationDerzko, C. M., Elliott, S., & Lam, W. (2007) · Current Oncology · doi:10.3747/co.2007.151 · Cited by 105 · see citing works
Uterine and ovarian changes during testosterone administration in young female-to-male transsexuals
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“In recent years, a number of therapeutic protocols have included androgens as part of the traditional postmenopausal hormonal therapy [1,2], although there are few efficacy data.”
BackgroundWomen's sexual function and dysfunction: current uncertainties, future directions
Basson, R. J. (2008) · International Journal of Impotence Research · doi:10.1038/ijir.2008.23 · Cited by 102 · see citing works
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“We are unaware of evidence that testosterone improves clinically relevant outcomes, such as physical performance or cognitive function, in older women (35, 37).”
BackgroundStuckey, B. G. A. (2008) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2008.00992.x · Cited by 97 · see citing works
Role of androgens in women's sexual dysfunction
Basson, R. J., Brotto, L. A., Petkau, A. J., & Labrie, F. (2010) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3181d59765 · Cited by 97 · see citing works
“While acknowledging that neither measurement of intracrine testosterone nor the use of mass spectrometry measurement of serum testosterone was used, previous epidemiological studies suggest that natural menopause per se has little effect on testosterone production.(24) In keeping with their older ages, compared with c…”
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“In addition to progesterone, androgen levels also decrease during the menopausal transition (3) and could contribute to bone”
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A Practitioner's Toolkit for Managing the Menopause
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Self-citationThe varied nature of women's sexuality: Unresolved issues and a theoretical approach
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“Women endorsing the Basson model had significantly lower FSFI scores (suggestive of problems with sexual functioning).”
InfluentialElraiyah, T. A., Sonbol, M. B., Wang, Z., Khairalseed, T., Asi, N., Undavalli, C., Nabhan, M., Firwana, B., Altayar, O., Prokop, L. J., et al. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-2262 · Cited by 86 · see citing works
“Eligible studies prior to July 2008 were identified from previous Endocrine Society guidelines (20), from a previously published systematic review addressing the same question by the Cochrane collaboration (21), and from a review about T without HRT (7).”
Androgens and the Regulation of Adiposity and Body Fat Distribution in Humans
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Managing female sexual dysfunction
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“Consensus reports from the Endocrine Society and the North American Menopause Society were initially cautionary (47, 48).”
Bhasin, S., Zhang, A., Coviello, A., Jasuja, R., Ulloor, J., Singh, R., Vesper, H., & Vasan, R. S. (2008) · Steroids · doi:10.1016/j.steroids.2008.07.003 · Cited by 79 · see citing works
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“Currently, there is inadequate evidence from long-term studies for the safety and efficacy of androgen therapy, thus recent guidelines recommend against their use in women [ 67 ].”
BackgroundTestosterone Treatment for Hypoactive Sexual Desire Disorder in Postmenopausal Women
Kingsberg, S. A. (2007) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2007.00449.x · Cited by 79 · see citing works
Inder, W. J., Jang, C., Obeyesekere, V. R., & ALFORD, F. P. (2009) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2009.03683.x · Cited by 78 · see citing works
Rariy, C. M., Ratcliffe, S. J., Weinstein, R. B., Bhasin, S., Blackman, M. R., Cauley, J. A., Robbins, J. B., Zmuda, J. M., Harris, T. B., & Cappola, A. R. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-0926 · Cited by 76 · see citing works
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“Graded as low quality when there is moderate quality evidence for benefits 8 Additional research We recommend additional investigation using rodents and primates to further define the specific targets of androgen action (16) 5 (4)”
BackgroundSalonia, A., Pontillo, M., Nappi, R. E., Zanni, G. E., Fabbri, F., Scavini, M., Daverio, R., Andrea Gallina, A., Rigatti, P., Bosi, E., et al. (2008) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2008.00791.x · Cited by 73 · see citing works
Testosterone, SHBG and cardiovascular health in postmenopausal women
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“17 These findings have raised questions regarding the safety of testosterone administration to postmenopausal women”
BackgroundAndrogens, health and sexuality in women and men
Wylie, K. R., REES, M. C. P., Hackett, G. I., Anderson, R. A., Bouloux, P.-M. G., Cust, M., Goldmeier, D., Kell, P. D., TERRY, T. R., TRINICK, T. R., et al. (2010) · Maturitas · doi:10.1016/j.maturitas.2010.07.011 · Cited by 72 · see citing works
“However, although supra-physiological doses of androgens can enhance genital engorgement [46], community-based and clinical studies with”
BackgroundInfluentialSantoro, N. F., Braunstein, G. D., Butts, C. L., Martin, K. A., McDermott, M., & Pinkerton, J. V. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-1271 · Cited by 72 · see citing works
“The preponderance of current data do not indicate that treating postmenopausal women to restore testosterone levels to those that normally occur in young reproductive females results in adverse cardiovascular, endometrial, or breast effects (94).”
BackgroundMethodInfluentialSelf-citationSexual dysfunction assessment and hormonal correlations in patients with polycystic ovary syndrome
Ercan, C. M., Çoksüer, H., Aydoğan, Ü., Alanbay, İ., Keskin, U., Karaşahin, K. E., & Basȩr, Ï. (2013) · International Journal of Impotence Research · doi:10.1038/ijir.2013.2 · Cited by 70 · see citing works
Androgen replacement therapy in Turner syndrome: a pilot study
Zuckerman-Levin, N., Frolova-Bishara, T., Militianu, D., Levin, M., Aharon-Peretz, J., & Hochberg, Z. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0514 · Cited by 69 · see citing works
“Recognizing the limitation in testosterone assays in women (16, 28), TS subjects of this study had low normal serum total testosterone, and its level increased on ART but remained in the normal range for women.”
BackgroundMethodAndrogen therapy for loss of desire in women: is the benefit worth the breast cancer risk?
Schover, L. R. (2007) · Fertility and Sterility · doi:10.1016/j.fertnstert.2007.05.057 · Cited by 69 · see citing works
“In 2003, the last year that sales figures were available, United States sales of DHEA totaled $47 million (10).”
BackgroundInfluentialSexuality and fertility in women with Addison's disease.
Erichsen, M. M., Husebye, E., Michelsen, T., Dahl, A., & Løvås, K. (2010) · Journal of Clinical Endocrinology and Metabolism · doi:10.1210/jc.2010-0445 · Cited by 66 · see citing works
Testosterone supplementation for depressed men: Current research and suggested treatment guidelines.
Kanayama, G., Amiaz, R., Seidman, S. N., & Pope, H. G. (2007) · Experimental and Clinical Psychopharmacology · doi:10.1037/1064-1297.15.6.529 · Cited by 65 · see citing works
Should the ovaries be removed or retained at the time of hysterectomy for benign disease?
Hickey, M., Ambekar, M., & Hammond, I. G. (2009) · Human Reproduction Update · doi:10.1093/humupd/dmp037 · Cited by 65 · see citing works
“benefit from testosterone supplementation, at least in the short term (Wierman et al., 2006).”
BackgroundEndocrine disorders and fertility and pregnancy: An update
Bednarska‐Czerwińska, A., Zmarzły, N., Morawiec, E., Panfil, A., Bryś, K., Czarniecka, J., Остенда, А., Dziobek, K., Sagan, D., Boroń, D., et al. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.970439 · Cited by 70 · see citing works
CDC project on standardizing steroid hormone measurements
Vesper, H. W., Botelho, J. C., Shacklady, C., Smith, A., & Myers, G. L. (2008) · Steroids · doi:10.1016/j.steroids.2008.09.008 · Cited by 64 · see citing works
“[16] Wierman ME, Basson R, Davis SR, Khosla S, Miller KK, Rosner W, et al.”
Strufaldi, R., Pompei, L. D. M., Steiner, M. L., Cunha, E. P., Ferreira, J. A. D. S., Peixoto, S. V., & Fernandes, C. E. (2010) · Contraception · doi:10.1016/j.contraception.2010.02.016 · Cited by 63 · see citing works
“It has also been noted that the free testosterone level below which female sexuality might effectively be diminished during the reproductive period remains unclear [19].”
BackgroundSteroid hormone profiling in obese and nonobese women with polycystic ovary syndrome
Deng, Y., Zhang, Y., Li, S., Zhou, W., Ye, L., Wang, L., Tao, T., Gu, J., Yang, Z., Zhao, D., et al. (2017) · Scientific Reports · doi:10.1038/s41598-017-14534-2 · Cited by 60 · see citing works
Traish, A. M., Guay, A. T., Spark, R. F., & the Testosterone Therapy in Women Study Group (2007) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2007.00584.x · Cited by 60 · see citing works
Female Sexual Health Consensus Clinical Guidelines
Lamont, J. A., Bajzak, K. I., Bouchard, C., Burnett, M. A., Byers, S. E., Cohen, T., Fisher, W. A., Holzapfel, S., & Senikas, V. (2012) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/s1701-2163(16)35341-5 · Cited by 60 · see citing works
Male hypogonadism associated with advanced cancer: a systematic review
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Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels
Elaut, E., Cuypere, G. D., Sutter, P. D., Gijs, L. A. C. L., van Trotsenburg, M., Heylens, G., Kaufman, J., Rubens, R., & T'Sjoen, G. G. (2008) · European Journal of Endocrinology · doi:10.1530/eje-07-0511 · Cited by 58 · see citing works
“Although a biopsychosocial approach to female sexuality remains in order, there seems to be a consensus upon the role of testosterone in motivational aspects of sexuality such as sexual desire (6, 7). Clinicians still wonder under which cut-off levels of free/testosterone complaints of low sexual desire most often occ…”
BackgroundInfluentialGuerrieri, G. M., Martinez, P. E., Klug, S. P., Haq, N., Vanderhoof, V. H., Koziol, D. E., Popat, V., Kalantaridou, S., Calis, K. A., Rubinow, D. R., et al. (2014) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000000195 · Cited by 54 · see citing works
“Because neither measures of depression nor quality of life improved after EPT-plus-testosterone treatment compared with EPT, our data suggest that, in women with POI, neither measure should be an indication for testosterone treatment, in keeping with current Clinical Practice Guidelines.51 The limitations of this stud…”
ResultSexual function in young women with spontaneous 46,XX primary ovarian insufficiency
Kalantaridou, S., Vanderhoof, V. H., Calis, K. A., Corrigan, E. C., Troendle, J. F., & Nelson, L. M. (2007) · Fertility and Sterility · doi:10.1016/j.fertnstert.2007.08.040 · Cited by 55 · see citing works
“The Endocrine Society has concluded that the female androgen deficiency syndrome is not presently well defined and that clinicians should not make this diagnosis in women until normative data on total and free testosterone levels have been established across the lifespan (31).”
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Testosterone therapy for sexual dysfunction in postmenopausal women
Hubayter, Z. R., & Simon, J. A. (2008) · Climacteric · doi:10.1080/13697130802162822 · Cited by 54 · see citing works
Menopause and sexuality: key issues in premature menopause and beyond
Graziottin, A. (2010) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2010.05680.x · Cited by 53 · see citing works
“However, controversy still exists on the indication of androgen therapy in women.(31) Tibolone and HT with estradiol and noretisterone are other options to improve sexual desire.”
BackgroundHormones and sexuality: Current complexities and future directions
Basson, R. J. (2007) · Maturitas · doi:10.1016/j.maturitas.2007.02.018 · Cited by 52 · see citing works
Self-citationAndrogen therapy in women: for whom and when
Pluchino, N., Carmignani, A., Cubeddu, A., Santoro, A. N., Cela, V., & Errasti, T. (2013) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-013-2969-7 · Cited by 53 · see citing works
“published setting the position of three societies about androgen therapy in women; the first in 2005 by the North American Menopause Society [16], the second a year later by The Endocrine Society [17] and the last in 2010 by The British Society for Sexual Medicine (BSSM) for the assessment of testosterone deficiency i…”
Androgen Physiology, Pharmacology, and Abuse
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Drug Insight: breast cancer prevention and tissue-targeted hormone replacement therapy
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Sowers, M., Zheng, H. T., McConnell, D. S., Nan, B., Karvonen-Gutierrez, C. A., & Randolph, J. F. (2009) · Human Reproduction · doi:10.1093/humrep/dep209 · Cited by 52 · see citing works
“There are a number of issues about the interpretation of T values in women being debated (Wierman et al., 2006).”
History of the Treatment of Female Sexual Dysfunction(s)
Kleinplatz, P. J. (2018) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050817-084802 · Cited by 51 · see citing works
SHUFELT, C. L., & Braunstein, G. D. (2008) · Menopause international · doi:10.1258/mi.2008.008015 · Cited by 51 · see citing works
Yarrow, J. F., Conover, C. F., Purandare, A. V., Bhakta, A. M., Zheng, N. N., Conrad, B. P., Altman, M. K., Franz, S. E., Wronski, T. J., & Borst, S. E. (2008) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.90640.2008 · Cited by 51 · see citing works
“Overall, supraphysiological testosterone administration may be capable of preventing androgen deficiency-related bone loss; however, the sex-specific skeletal responses following testosterone administration require clarification (26, 59).”
BackgroundJanse, F., Tanahatoe, S., Eijkemans, M. J. C., & Fauser, B. C. J. M. (2012) · Human Reproduction Update · doi:10.1093/humupd/dms013 · Cited by 51 · see citing works
“, 2007) and guidelines (North American Menopause Society, 2005) have advocated a beneficial effect of androgen therapy in hypoandrogenic women, the evidence is controversial and the Endocrine Society Clinical Practice Guidelines do not recommend androgen therapy until the physiological role of androgens has become cle…”
BackgroundOuyang, P., WENGER, N. K., Taylor, D. A., Rich-Edwards, J. W., Steiner, M. S., Shaw, L. J., Berga, S. L., Miller, V. M., & Merz, C. N. B. (2016) · Biology of Sex Differences · doi:10.1186/s13293-016-0073-y · Cited by 51 · see citing works
“Various immunoassay methodologies are commercially available [38, 40, 41].”
Roberts, H. (2007) · BMJ · doi:10.1136/bmj.39153.522535.be · Cited by 49 · see citing works
NOFSA Guideline for the Diagnosis and Management of Osteoporosis
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Sex-Based Differences in Vascular Function
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Approved Hormonal Treatments for HSDD: An Unmet Medical Need
Snabes, M. C., & Simes, S. M. (2009) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2009.01294.x · Cited by 46 · see citing works
- Authors
- Wierman, M. E., Basson, R., Davis, S. R., Khosla, S., Miller, K. K., Rosner, W., & Santoro, N.
- Affiliations
- University of Colorado Denver (US)
- University of British Columbia (CA)
- The Alfred Hospital (AU)
- Mayo Clinic (US)
- Massachusetts General Hospital (US)
- St. Luke's-Roosevelt Hospital Center (US)
- Albert Einstein College of Medicine (US)
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2006-10-01
- Volume
- 91
- Issue
- 10
- Pages
- 3697-3710
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2118649626
- Cited by
- 301
- References
- 165
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 5 · 2019: 8 · 2018: 13 · 2017: 8 · 2016: 17 · 2015: 9 · 2014: 17 · 2013: 13 · 2012: 25
- FWCI
- 24.23
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- treatment, androgen therapy, testosterone, women, androgen deficiency, surgical menopause, hormone replacement therapy, long-term safety, quality of evidence, strength of recommendation, menopausal symptoms, cardiovascular risk, bone mineral density, cancer risk, quality of life, sexual function, sleep apnea
- MeSH terms
- Affect, Aging, Anorexia Nervosa, Body Composition, Cognition, Female, Humans, Hypopituitarism, Menopause, Sexual Dysfunction, Physiological, Testosterone, Evidence-Based Medicine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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