Testosterone for Women: The Levels Necessary to Achieve Symptom Improvement
In the first course, Testosterone for Women (Part I), I reviewed the current controversy in prescribing testosterone to women. In a separate consensus paper that is different from the one discussed in the first course, the authors recommend testosterone replacement based on symptoms and signs and not on serum levels. In fact, in this second consensus paper from “experts that have experience in the field of testosterone administration,” the authors stressed the importance of replacing testosterone to improve symptoms and not by being guided by numbers or levels. These authors specifically emphasized that testosterone should be supplemented based on symptoms and not just on serum levels alone, as testosterone levels do not correlate with symptoms as per much of the medical literature. The authors also suggested that testosterone should be dosed and adjusted based on symptom improvement, and not by testosterone levels. The authors reiterated that no number (or testosterone level) denotes a deficiency as symptoms denote a deficiency. Furthermore, improvement in symptoms do not correlate with numbers either as all women will respond differently and not based on any number. So, in contrast to men where the guidelines state that we must follow levels and numbers, these guidelines for women recommend that we do not test baseline levels nor treatment levels, rather symptoms should guide treatment initiation.