Androgen Therapy for Menopause: New Latin American Position Statement

Androgen Therapy for Menopause: What a New Latin American Position Statement Says

A team of leading gynecological endocrinologists across Latin America has analyzed decades of data to issue a clear, evidence-based stance on using hormones like testosterone for menopausal symptoms. Their work, published by the Latin American Association of Gynecological Endocrinology (ALEG) in the journal Climacteric, focuses on a treatment often prescribed without standardized guidelines in the region.

The Precise, Limited Role for Testosterone

The ALEG panel, led by Dr. Silvia Pilnik of the Hospital Italiano de Buenos Aires, concluded with high-grade certainty that testosterone should be reserved for one primary indication: treating hypoactive sexual desire disorder (HSDD) in postmenopausal women. This diagnosis requires a formal evaluation that considers biological, psychological, and social factors, not just a complaint of low libido. The group specifically advises against using testosterone for fatigue, low mood, or other non-specific complaints, citing insufficient evidence.

The position statement makes a critical distinction between symptom relief and diagnostic testing. While hormone levels naturally decline, the panel gives a Grade A (high) recommendation against routine serum measurements of testosterone for diagnosis. These levels do not reliably correlate with symptoms. However, they advise checking a baseline level before starting therapy to rule out an already elevated concentration, which could increase risks.

Caution on Compounded “Bioidentical” Androgens and Dosing

A significant part of the panel’s guidance addresses the form and dose of therapy. They strongly prefer transdermal formulations—patches or gels—because they provide a steady, physiological dose that can be easily adjusted. The goal is to keep a woman’s testosterone levels within the normal range seen in premenopausal women, typically monitoring response within 3 to 6 weeks of starting.

The statement explicitly warns against two alternatives. First, subcutaneous testosterone pellets, which can release unpredictable, supraphysiological doses. Second, and notably, compounded “bioidentical” testosterone. The panel states these custom-mixed products are not recommended due to risks of incorrect dosing, lack of standardized strength, and insufficient evidence for their safety and efficacy. This highlights a gap between marketing claims and clinical evidence for some bioidentical hormone products.

DHEA’s Narrow, Localized Application

The review also clarifies the role of dehydroepiandrosterone (DHEA), another androgen precursor often marketed as a supplement for vitality and libido. The panel’s conclusion is firm: systemic oral DHEA is not advised for treating sexual symptoms in midlife and older women (Grade A: High). The evidence simply does not support its use for this purpose.

However, the statement notes that vaginal DHEA is an FDA-approved and effective treatment for the genitourinary syndrome of menopause (GSM), which includes vaginal dryness and pain during intercourse. This underscores a principle of hormone therapy: the route of administration dramatically changes its effects and safety profile. A treatment applied locally for a local issue, like other non-hormonal treatments for GSM, is fundamentally different from one taken orally to affect the whole body.

Navigating Treatment in a Regulatory Gap

The Latin American perspective brings a crucial practical reality to the fore. As noted by the authors, including Dr. Peter Chedraui from Universidad Espíritu Santo in Ecuador, no androgenic products are specifically approved for women in the region. This regulatory gap forces clinicians to prescribe products formulated and dosed for men, or to rely on non-standardized compounded preparations. Both scenarios increase the risk of side effects from overly high doses, such as acne, hair growth, and potentially negative impacts on cholesterol.

This context makes the panel’s call for strict adherence to clinical guidelines and thorough patient counseling even more urgent. They stress that any use of testosterone for women remains “off-label,” and patients must be fully informed of this and the potential unknowns about long-term risks. The statement serves as a direct call to improve medical practice and protect patients in an environment where clear regulations are lacking.

Conclusion

The Latin American Association of Gynecological Endocrinology provides a conservative, evidence-anchored framework for using androgens in menopause. Testosterone has a validated but narrow role for HSDD, should be delivered via transdermal methods, and requires careful monitoring. Patients and providers should view compounded testosterone and oral DHEA supplements for sexual health with significant skepticism.

Sources:
https://pubmed.ncbi.nlm.nih.gov/40919649/
https://pubmed.ncbi.nlm.nih.gov/40109076/
https://pubmed.ncbi.nlm.nih.gov/38980733/