Androgen therapy in women: a reappraisal: an Endocrine Society Clinical Practice Guideline

Wierman, Margaret E.; Arlt, Wiebke; Basson, Rosemary; Davis, Susan R.; Miller, Karen K.; Murad, Mohammad H.; Rosner, William; Santoro, Nanette

doi:10.1210/jc.2014-2260

Cited by 363Hormonal and reproductive studiesAdrenal Hormones and DisordersMenopause: Health Impacts and Treatments

Androgen therapy in women: a reappraisal: an Endocrine Society Clinical Practice Guideline

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Wierman, Margaret E., Arlt, Wiebke, Basson, Rosemary, Davis, Susan R., Miller, Karen K., Murad, Mohammad H., Rosner, William, Santoro, Nanette·2014·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2014-2260

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Abstract

OBJECTIVE: To update practice guidelines for the therapeutic use of androgens in women. PARTICIPANTS: A Task Force appointed by the Endocrine Society, American Congress of Obestricians and Gynecologists (ACOG), American Society for Reproductive Medicine (ASRM), European Society of Endocrinology (ESE), and International Menopause Society (IMS) consisting of six experts, a methodologist, and a medical writer. EVIDENCE: The Task Force commissioned two systematic reviews of published data and considered several other existing meta-analyses and trials. The GRADE methodology was used; the strength of a recommendation is indicated by a number "1" (strong recommendation, we recommend) or "2" (weak recommendation, we suggest). CONSENSUS PROCESS: Multiple e-mail communications and conference calls determined consensus. Committees of the Endocrine Society, ASRM, ACOG, ESE, and IMS reviewed and commented on the drafts of the guidelines. CONCLUSIONS: We continue to recommend against making a diagnosis of androgen deficiency syndrome in healthy women because there is a lack of a well-defined syndrome, and data correlating androgen levels with specific signs or symptoms are unavailable. We recommend against the general use of T for the following indications: infertility; sexual dysfunction other than hypoactive sexual desire disorder; cognitive, cardiovascular, metabolic, or bone health; or general well-being. We recommend against the routine use of dehydroepiandrosterone due to limited data concerning its effectiveness and safety in normal women or those with adrenal insufficiency. We recommend against the routine prescription of T or dehydroepiandrosterone for the treatment of women with low androgen levels due to hypopituitarism, adrenal insufficiency, surgical menopause, pharmacological glucocorticoid administration, or other conditions associated with low androgen levels because there are limited data supporting improvement in signs and symptoms with therapy and no long-term studies of risk. Evidence supports the short-term efficacy and safety of high physiological doses of T treatment of postmenopausal women with sexual dysfunction due to hypoactive sexual desire disorder. Importantly, endogenous T levels did not predict response to therapy. At present, physiological T preparations for use in women are not available in many countries including the United States, and long-term safety data are lacking. We recommend that any woman receiving T therapy be monitored for signs and symptoms of androgen excess. We outline areas for future research. Ongoing improvement in androgen assays will allow a redefinition of normal ranges across the lifespan; this may help to clarify the impact of varying concentrations of plasma androgens on the biology, physiology, and psychology in women and lead to indications for therapeutic interventions.

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DHEA-S Levels and Cardiovascular Disease Mortality in Postmenopausal Women: Results from the National Institutes of Health—National Heart, Lung, and Blood Institute (NHLBI)-Sponsored Women’s Ischemia Syndrome Evaluation (WISE)
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Research works printed but not linked: 6

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Authors: Wierman, M. E., Arlt, W., Basson, R., Davis, S. R., Miller, K. K., Murad, M. H., Rosner, W., & Santoro, N.
Affiliations: University of British Columbia (CA)
University of Birmingham (GB)
Veterans Health Administration (US)
Massachusetts General Hospital (US)
Mayo Clinic (US)
ORCID: Wierman, Margaret E.
Arlt, Wiebke
Basson, Rosemary
Davis, Susan R.
Miller, Karen K.
Murad, Mohammad H.
Santoro, Nanette
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 2014-10
Volume: 99
Issue: 10
Pages: 3489-3510
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jc.2014-2260
OpenAlex: W2169638329
Semantic Scholar: 0ab9fec7488d4092d18727dbe6ea5d548da84c6e
Cited by: 363
References: 257
Citations by year: 2026: 18 · 2025: 24 · 2024: 27 · 2023: 22 · 2022: 52 · 2021: 46 · 2020: 28 · 2019: 25 · 2018: 31 · 2017: 27 · 2016: 34 · 2015: 25 · 2014: 3
FWCI: 23.88
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords: androgen therapy, women, testosterone, dehydroepiandrosterone, hypoactive sexual desire disorder, postmenopausal women, adrenal insufficiency, hypopituitarism, surgical menopause, hyperandrogenism, infertility, sexual dysfunction, bone health, cardiovascular risk, treatment safety
MeSH terms: Contraindications, Androgens, Endocrinology, Female, Humans, Hypopituitarism, Societies, Medical, Practice Guidelines as Topic, Evidence-Based Medicine, Hormone Replacement Therapy

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Androgen therapy in women: a reappraisal: an Endocrine Society Clinical Practice Guideline

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