Androgen therapy in midlife and older women: a position statement of the Latin American Association of Gynecological Endocrinology (ALEG)

Androgens have been prescribed to alleviate symptoms in midlife women, but evidence regarding benefits and risks remains limited, with no clearly established indications for Testosterone therapy. In many Latin American countries, Testosterone is prescribed without specific guidelines, making it difficult to identify patients who might benefit. This position statement aims to summarize evidence and provide a Latin American perspective on androgen therapy in midlife and older women.

Data were collected from Cochrane reviews, placebo-controlled studies, meta-analyses, international guidelines, consensus statements, and government regulations published between 2000 and the present. Analyses focused on efficacy, safety, and clinical recommendations for androgen therapy in midlife and older women.

Testosterone therapy for postmenopausal women should be limited to those with hypoactive sexual desire disorder (HSDD) confirmed through a formal biopsychosocial evaluation (Grade A: High). Routine serum measurements of Testosterone or other androgens are not recommended for diagnosis (Grade A: High), but baseline levels should be checked before therapy to exclude elevated concentrations (Grade C: Low). Treatment monitoring should occur within 3-6 weeks, maintaining Testosterone within the premenopausal physiological range (Grade C: Low). Transdermal formulations are preferred. Subcutaneous pellets and compounded "bioidentical" Testosterone are not recommended due to risks of supraphysiological dosing and insufficient evidence (Grade C: Low). Oral dehydroepiandrosterone (DHEA) is not advised systemically (Grade A: High). Vaginal DHEA is approved only for genitourinary syndrome of menopause.

Women should receive counseling aligned with current clinical guidelines. Prior to initiating Testosterone therapy, patients must be informed that its use is off-label. Evidence to date does not support systemic DHEA as an effective treatment for sexual symptoms.

In many Latin American countries, Testosterone is prescribed without structured guidelines, creating challenges in determining who would benefit from this therapy or face its potential associated risks, both in the short and long term. Currently, there are no androgenic products specifically approved for women in Latin America, leading to the use of products designed and certified for men or with non-standardized formulations, which increase risks. The aim of our scientific society is to promote good medical practices; hence, this document has been written after analyzing consistent publications and international guidelines, consensus statements and regional government regulations. Our recommendations on the indication of Testosterone therapy for postmenopausal women should be limited to those diagnosed with hypoactive sexual desire disorder. If indicated, the transdermal route is preferred. Treatment with subcutaneous tablets, bioidentical Testosterone and oral dehydroepiandrosterone is not recommended. Vaginal dehydroepiandrosterone preparations are only approved for treatment of the genitourinary syndrome of menopause. Women should receive counseling according to current clinical guidelines, and before prescribing Testosterone therapy they should be informed that such use is considered off-label.