| name | endo-t-generalized-use-against |
| description | The guideline recommends against generalized testosterone use for indications such as infertility, sexual dysfunction other than HSDD, cognitive, cardiovascular, metabolic, bone health, or general well-being due to insufficient evidence of benefit and lacking long-term safety data. Consider this recommendation when a clinician contemplates prescribing testosterone for any indication other than confirmed hypoactive sexual desire disorder in postmenopausal women. |
Recommend against generalized testosterone use for non-HSDD indications
STEP 1 — Gather Information
Collect the specific indication for testosterone request, confirm menopausal status, and determine whether a diagnosis of hypoactive sexual desire disorder (HSDD) has been established.
Action: Proceed to step 2.
STEP 2 — Rule In / Rule Out
Determine if the indication is HSDD in a postmenopausal woman.
Action: If yes, testosterone may be considered per recommendation 4.1 (outside this skill); if no, proceed to step 3.
STEP 3 — Classify or Stratify
Classify the non-HSDD indication into one of the following categories: infertility, sexual dysfunction other than HSDD, cognitive dysfunction, cardiovascular dysfunction, metabolic dysfunction, bone health, or general well-being.
Action: Proceed to step 4.
STEP 4 — Decide
Recommend against prescribing testosterone for the given indication due to lack of clear indications and insufficient long-term safety data.
Action: Do not initiate testosterone therapy; discuss alternative approaches.
Clinical Guardrails / Mimics / Pitfalls
Do not prescribe testosterone for non-HSDD indications based on low androgen levels alone; avoid unapproved or compounded formulations lacking safety data; do not use testosterone to treat fatigue, mood, or cognitive symptoms without an HSDD diagnosis; monitor for signs of androgen excess (acne, hirsutism, voice changes) if testosterone is used off-label; recognize that government‑approved dose‑appropriate preparations for women are not widely available.
Concrete Clinical Example
A 58‑year‑old postmenopausal woman presents with low energy and decreased libido but does not meet criteria for HSDD. She requests testosterone for “vitality.” The clinician gathers information, confirms the indication is not HSDD, classifies it as general well‑being, and recommends against testosterone, discussing lifestyle modifications and evaluating for other causes of fatigue.
Source: Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline, Endocrine Society, American Congress of Obstetricians and Gynecologists (ACOG), American Society for Reproductive Medicine (ASRM), European Society of Endocrinology (ESE), International Menopause Society (IMS), 2014, DOI:10.1210/jc.2014-2260
