Testosterone in Females

Abstract

Although testosterone (T) is known for being the major sex hormone in males, androgens circulate at relatively high levels also in women throughout their lifespan, playing an important role in maintaining bone metabolism, cognition, and sexual function. To date, the diagnosis of androgen deficiency in women poses considerable controversies, principally due to the lack of both a well-defined clinical syndrome with specific signs and symptoms and female, age-based, standardized reference ranges for serum T and free T concentrations. However, there are many identifiable causes leading to a clinical condition characterized by a lack of androgen action in women. Particularly relevant is its manifestation as reduced sexual motivation and desire, which is related to aging-related androgen decline in natural menopause and abrupt cessation of androgen production in surgical menopause. A 2019 Global Position Statement recommends the use of T therapy – with or without concurrent estrogen therapy – in natural or surgical postmenopausal women diagnosed with hypoactive sexual desire disorder (HSDD), when all biopsychosocial modifiable factors have been addressed. Despite the need of adequately powered randomized clinical trials to further assess the long-term safety of T treatment and its pleiotropic effects, available evidence suggests a new role of T as a fundamental hormone in women sexual well-being.