USPSTF Assessment of Magnitude of Net Benefit

The US Preventive Services Task Force (USPSTF) concludes with moderate certainty that screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older has moderate net benefit.

Treatment

The US Food and Drug Administration has approved several drug therapies for the treatment or prevention of osteoporosis, including bisphosphonates, denosumab, romosozumab, parathyroid hormone, raloxifene, calcitonin, and estrogen (with or without progesterone).

Is your Doctor a Menopause Expert??

You Tube video of Dr. Mary Claire Haver and Dr. Vonda Wright discussing Menopause therapy.

As we age, our testosterone — like our other hormones — declines, and many middle-aged women have what’s considered “low” levels of the hormone. I get asked all the time in my practice, “Should midlife women with low libido be treated with testosterone?”

About the time we enter perimenopause and menopause, our lower testosterone levels can certainly affect our intimate relationships. About 40 percent of American women report having a sexual problem, with 12 percent of those saying that issues in the bedroom cause them personal anguish. While sexual dysfunction generally worsens as people age, severe sexual dysfunction peaks for women in midlife (between the ages of 45 and 64). The most prevalent sexual issue for women is hypoactive sexual desire disorder (HSDD), which is characterized by low libido and accompanying distress.

For women experiencing low libido, especially around menopause when hormone levels fluctuate, testosterone therapy may be considered as part of a broader treatment plan. The goal is to restore levels to the normal physiological range for women, improving sexual desire without pushing the body into a “male” hormone profile. Studies have shown that for some women, boosting testosterone levels can lead to noticeable improvements in sexual desire, frequency of sexual thoughts, and overall sexual satisfaction.

Although no testosterone product is currently approved for the treatment of HSDD in women in the U.S., it’s commonly prescribed off-label. Often, healthcare providers will recommend using a compounded topical cream or pellet.

• How much testosterone should I take? The dose should be individualized. You must work with a knowledgeable healthcare professional to find what will work for you. Based on studies in postmenopausal women with HSDD, the starting dose of testosterone gel was 5 mg per day (0.5 ml), which is one-tenth the starting dose used in men. Small increases can be made up to 10  mg per day (1.0 ml) if needed.
• What do I need to get checked? Baseline testosterone level, lipid panel, and liver function tests should be monitored at least yearly during testosterone therapy.
• How long until it kicks in? Clinical benefits may be seen within six to eight weeks, but maximum results can take up to 12 weeks. If you don’t notice a benefit after six months, you should stop using it.
• What are the risks? Potential side effects include acne, deepening of the voice, alopecia, changes in lipid profile, and abnormal hair growth. However, testosterone may also have protective effects against breast cancer.
• Wash those hands! Don’t forget to cover the area and wash your hands after applying testosterone products to your skin.

It’s important to note that although there are more than 30 approved testosterone products for men, there are no FDA-approved testosterone options for women. (Excuse me while I go scream into the void.) That’s why it’s crucial you consult a knowledgeable healthcare provider.

Women need to know that HSDD is a legitimate medical concern, not just something they have to “push through.” Proper medical evaluation, including hormone levels, psychological health, and alternative treatments like counseling with a sexual health expert, can lead to real improvements in sexual desire and overall well-being. The key is getting the proper support and avoiding the dismissive advice that too many women have heard.