Androgen treatment of postmenopausal women

•Brief review of normal androgen physiology in women.•Causes of low androgen levels in women.•Relationship between androgens and sexual function in women.•Current evidence for the use of testosterone therapy in women with sexual dysfunction.•Other effects of testosterone therapy.•Safety concerns.•Appropriate candidates for treatment.

Testosterone is physiologically important for women. Serum testosterone levels decline with age, with the most precipitous fall being prior to menopause. There is no level of testosterone which defines a woman as being testosterone deficient. However, there is substantial high quality evidence to support the use of testosterone for the treatment of hypoactive sexual desire disorder in postmenopausal women. Although preliminary data suggests testosterone has favorable effects on bone and muscle mass, cognitive function and the cardiovascular system, further research regarding its therapeutic effects in these domains is warranted. As no testosterone product has been approved for women there is extensive off-label prescribing of testosterone products for women as well as the prescription of compounded therapy. This raises serious safety concerns and together with the evidence for the negative impact of FSD on quality of life, highlights the need for an approved testosterone formulation for women.This article is part of a Special Issue entitled ‘Menopause’.