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      Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism

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          ABSTRACT

          Objective

          To summarize current evidence regarding testosterone treatment for women with low sexual desire.

          Materials and methods

          The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies.

          Results

          Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women.

          Conclusion

          Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. Arch Endocrinol Metab. 2019;63(3):190-8

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          Most cited references76

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          Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement.

          The objective of the study was to evaluate the current state of clinical assays for total and free testosterone. The five participants were appointed by the Council of The Endocrine Society and charged with attaining the objective using published data and expert opinion. Data were gleaned from published sources via online databases (principally PubMed, Ovid MEDLINE, Google Scholar), the College of American Pathologists, and the clinical and laboratory experiences of the participants. The statement was an effort of the committee and was reviewed in detail by each member. The Council of The Endocrine Society reviewed a late draft and made specific recommendations. Laboratory proficiency testing should be based on the ability to measure accurately and precisely samples containing known concentrations of testosterone, not only on agreement with others using the same method. When such standardization is in place, normative values for total and free testosterone should be established for both genders and children, taking into account the many variables that influence serum testosterone concentration.
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            Androgen production in women.

            To describe the sources, production rates, circulating concentrations, and regulatory mechanisms of the major androgen precursors and androgens in women. Review of the major published literature. Quantitatively, women secrete greater amounts of androgen than of estrogen. The major circulating steroids generally classified as androgens include dehydroepiandrosterone sulphate (DHEAS), dehydroepiandrosterone (DHEA), androstenedione (A), testosterone (T), and dihydrotestosterone in descending order of serum concentration, though only the latter two bind the androgen receptor. The other three steroids are better considered as pro-androgens. Dehydroepiandrosterone is primarily an adrenal product, regulated by adrenocorticotropic hormone (ACTH) and acting as a precursor for the peripheral synthesis of more potent androgens. Dehydroepiandrosterone is produced by both the ovary and adrenal, as well as being derived from circulating DHEAS. Androstenedione and testosterone are products of the ovary and the adrenal. Testosterone circulates both in its free form, and bound to protein including albumin and sex steroid hormone-binding globulin (SHBG), the levels of which are an important determinant of free testosterone concentration. The postmenopausal ovary is an androgen-secreting organ and the levels of testosterone are not directly influenced by the menopausal transition or the occurrence of menopause. Dihydrotestosterone (DHT) is primarily a peripheral product of testosterone metabolism. Severe androgen deficiency occurs in hypopituitarism, but other causes may lead to androgen deficiency, including Addison's disease, corticosteroid therapy, chronic illness, estrogen replacement (leads to elevated SHBG and, therefore, low free testosterone), premenopausal ovarian failure, or oophorectomy.
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              Definitions of Sexual Dysfunctions in Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015.

              Definitions of sexual dysfunctions in women and men are critical in facilitating research and enabling clinicians to communicate accurately.
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                Author and article information

                Journal
                Arch Endocrinol Metab
                Arch Endocrinol Metab
                aem
                Archives of Endocrinology and Metabolism
                Sociedade Brasileira de Endocrinologia e Metabologia
                2359-3997
                2359-4292
                12 July 2019
                May-Jun 2019
                : 63
                : 3
                : 190-198
                Affiliations
                [1 ] normalizedPontifícia Universidade Católica do Rio de Janeiro orgdiv2Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione orgnamePontifícia Universidade Católica do Rio de Janeiro orgdiv1Escola Médica de Pós-Graduação em Endocrinologia Rio de Janeiro RJ Brasil originalInstituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Pontifícia Universidade Católica do Rio de Janeiro, Escola Médica de Pós-Graduação em Endocrinologia (IEDE-PUC/RJ), Rio de Janeiro, RJ, Brasil
                [2 ] normalizedUniversidade Federal de Santa Catarina orgdiv2Departamento de Medicina Interna orgdiv1Hospital Universitário orgnameUniversidade Federal de Santa Catarina Florianópolis SC Brasil originalServiço de Endocrinologia e Metabolismo, Departamento de Medicina Interna, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brasil
                [3 ] normalizedUniversidade Federal do Rio de Janeiro orgnameUniversidade Federal do Rio de Janeiro Rio de Janeiro RJ Brasil originalUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
                [4 ] normalizedUniversidade Federal de São Paulo orgnameUniversidade Federal de São Paulo São Paulo SP Brasil originalDisciplina de Endocrinologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
                [5 ] normalizedUniversidade de São Paulo orgdiv1Faculdade de Medicina orgdiv2Hospital de Clínicas orgnameUniversidade de São Paulo São Paulo SP Brasil originalDisciplina de Endocrinologia, Faculdade de Medicina, Hospital de Clínicas, Universidade de São Paulo (USP), São Paulo, SP, Brasil
                [6 ] normalizedInstituto de Medicina Integral Professor Fernando Figueira orgnameInstituto de Medicina Integral Professor Fernando Figueira Recife PE Brasil originalInstituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil
                [7 ] orgnameDepartamento de Fisiologia Endócrina e Fisiologia orgdiv1Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular Rio de Janeiro RJ Brasil originalDepartamento de Fisiologia Endócrina e Fisiologia e Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular (BIOVASC), Rio de Janeiro, RJ, Brasil
                [8 ] normalizedUniversidade Federal do Rio Grande do Sul orgdiv1Hospital de Clínicas de Porto Alegre orgdiv2Departamento de Fisiologia orgnameUniversidade Federal do Rio Grande do Sul Porto Alegre RS Brasil originalUnidade de Endocrinologia Ginecológica, Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre e Departamento de Fisiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
                Author notes
                Correspondence to: Poli Mara Spritzer Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre Rua Ramiro Barcelos, 2350 Porto Alegre, RS, Brasil 90035-003 spritzer@ 123456ufrgs.br

                Disclosure: the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

                Author information
                https://orcid.org/0000-0002-6294-6825
                https://orcid.org/0000-0002-8073-5837
                https://orcid.org/0000-0003-1865-4785
                https://orcid.org/0000-0002-4091-1621
                https://orcid.org/0000-0002-0902-0142
                https://orcid.org/0000-0001-9140-2555
                https://orcid.org/0000-0002-1981-9855
                https://orcid.org/0000-0002-3153-7199
                https://orcid.org/0000-0002-6734-7688
                Article
                2359-3997000000152
                10.20945/2359-3997000000152
                10522198
                31340240
                688925cd-6f8a-4718-9028-600db39073a1

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 2 January 2019
                : 22 April 2019
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 72, Pages: 9
                Categories
                Consensus

                testosterone therapy,female sexual disorder,position

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