Androgens are a group of hormones, including testosterone, that play a key role in sexual health. As women age, their testosterone production decreases, potentially contributing to sexual dysfunctions like hypoactive sexual desire disorder (HSDD). HSDD is a condition characterized by a persistent lack or absence of sexual desire or interest in sexual activity, causing distress or difficulties in intimate relationships.

Testosterone therapy (TTh) is considered for postmenopausal women with HSDD. However, safety data on TTh in women is limited, especially regarding long-term effects like cardiovascular events and breast cancer.

A new study explored the risks of major adverse cardiac events (MACE) and breast cancer following TTh in a large group of women. It also examined other potential side effects, such as venous emboli (blood clots that form in veins), pulmonary embolism (blood clots in the lungs), and hirsutism (hair growth in unusual places caused by hormonal imbalances), aiming to provide insights for healthcare providers navigating TTh prescriptions in women.

The researchers used electronic health records from a database covering over 200 million patients worldwide, focusing on adult women aged 18 years and older. Data from 2009 to 2022 were analyzed, examining diagnoses and treatments, including testosterone prescriptions. Patients with a history of heart failure, unstable angina, intersex surgery (female to male), a personal history of sex reassignment, or gender identity disorders were excluded.

Statistical analyses assessed the risk of heart events, blood clots, pulmonary embolism, and breast cancer in women following TTh. Patients were assigned to the TTh group if they had received ≥3 injectable or topical testosterone prescriptions within a time frame ranging from 1 month to 1 year. Other patients who did not receive TTh were included in the control group.

The study identified 16,783 adult females with three or more testosterone prescriptions, receiving them on average at age 41.2. After matching the women in the TTh group with controls, the study found that those receiving testosterone had significantly lower risks of heart events, blood clots, pulmonary embolism, and breast cancer within one month to three years after starting testosterone therapy. On the other hand, they had a higher risk of hirsutism. Subgroup analyses by age showed similar trends, with younger and older women experiencing comparable outcomes.

Overall, these findings suggest that testosterone therapy does not increase a woman’s risk of major adverse cardiac events or breast cancer. However, there are complexities and careful consideration is needed for potential side effects like hirsutism. The study has limitations, but it provides valuable insights into TTh’s safety for women’s health.

References:

• Agrawal, P., Singh, S. M., Hsueh, J., Grutman, A., An, C., Able, C., Choi, U., Kohn, J., Clifton, M., & Kohn, T. P. (2024). Testosterone therapy in females is not associated with increased cardiovascular or breast cancer risk: A claims database analysis. The Journal of Sexual Medicine, 21(5), 414–419. https://doi.org/10.1093/jsxmed/qdae032