Testosterone for Menopause: Latin American Position Statement

Clarity on Testosterone in Menopause: A Latin American Position Statement

The Latin American Association of Gynecological Endocrinology (ALEG) has published a formal position on the use of androgens like Testosterone in midlife and older women. Led by Dr. Silvina Pilnik of the Hospital Italiano de Buenos Aires, the statement aims to bring order to a treatment area often characterized by off-label use and compounded preparations labeled as “bioidentical.” Their conclusion is clear: the role of Testosterone for women is exceptionally narrow.

One Approved Indication: HSDD After Full Evaluation

The panel’s strongest recommendation, graded “A: High,” is that Testosterone therapy should be reserved for postmenopausal women with hypoactive sexual desire disorder. HSDD is not simply a fleeting dip in libido; it is a persistent absence of sexual fantasies and desire that causes personal distress. The ALEG stresses this diagnosis must be confirmed through a formal biopsychosocial evaluation. This process assesses relationship dynamics, mental health, medication use, and other medical conditions before considering a hormonal cause. This careful approach prevents Testosterone from being used as a first-line solution for complex issues that may have non-hormonal roots, such as relationship stress or the cognitive changes some women experience during the menopausal transition, which are explored in related research on menopause brain fog and cellular aging.

The Problem with Compounded “Bioidentical” Androgens

A significant part of the position statement addresses the use of non-standardized formulations, specifically subcutaneous pellets and compounded “bioidentical” Testosterone. The authors assign these a “Grade C: Low” recommendation, advising against their use. The term “bioidentical” is often marketed to imply naturalness and safety, but in this context, it refers to custom-mixed preparations that are not regulated for consistent dosage or purity. The ALEG notes these formulations carry a significant risk of supraphysiological dosing—delivering hormone levels far above the normal range for women. This can lead to unwanted androgenic side effects like acne, hair loss, and voice deepening. More concerning are the unknown long-term risks on cardiovascular and breast health. The statement favors transdermal gels or creams, which allow for better dose control and easier adjustment.

DHEA: A Systemic Supplement Without Systemic Benefit

The panel also examined the androgen precursor dehydroepiandrosterone (DHEA), often sold as an oral supplement for energy, vitality, and sexual function. Their verdict, based on the reviewed evidence, is a firm “Grade A: High” against its systemic use for sexual symptoms in menopausal women. The data does not support oral DHEA as an effective treatment for low libido or other sexual complaints. There is, however, one approved application: vaginal DHEA (prasterone) is a licensed treatment for the genitourinary syndrome of menopause (GSM), which includes vaginal dryness and pain during intercourse. This local application is distinct from taking DHEA orally with the hope of systemic effects on desire. For other GSM treatments, readers may find our article on non-hormonal options for GSM informative.

Navigating Therapy: No Routine Tests, But Mandatory Monitoring

The ALEG provides specific, and sometimes counterintuitive, guidance on testing. First, they state that routine serum measurements of Testosterone or other androgens should not be used to diagnose a deficiency in women. Blood levels correlate poorly with symptoms, and “low” levels are difficult to define. However, they recommend obtaining a baseline Testosterone level before starting therapy for a critical reason: to exclude women who already have elevated concentrations, for whom adding more hormone would be inappropriate. Once therapy begins, monitoring is essential. Patients should be reassessed within 3-6 weeks, with the goal of keeping serum Testosterone levels within the physiological range for premenopausal women. This tight monitoring protocol is a direct response to the risks posed by unregulated compounded products, which make controlled dosing nearly impossible.

Putting Evidence into Practice

For women considering this path, the practical implications are straightforward but strict. Any discussion about Testosterone must start with the fact that its use for female HSDD is off-label. In Latin America, as the statement notes, this leads to the adaptation of products formulated and dosed for men, which increases risk. The safest approach is to seek a clinician who follows structured guidelines, prioritizes transdermal formulations, and commits to regular monitoring. For symptoms beyond HSDD—such as fatigue, low mood, or weight changes—the evidence does not support Testosterone as a solution. Managing overall health during menopause, including addressing factors like stress-related cortisol which can impact symptoms like bloating, requires a broader, integrated strategy.

This position statement from the ALEG moves the conversation on androgen therapy from one of broad potential to one of precise application. It narrows the window for appropriate use to a single, well-defined condition and explicitly discourages popular but poorly evidenced alternatives like compounded pellets and oral DHEA supplements.

Sources:
https://pubmed.ncbi.nlm.nih.gov/40919649/