Patient information: See related handout on testosterone therapy , written by the authors of this article.

Testosterone treatment is controversial for men and even more so for women. Although long-term outcome data are not available, prescriptions for testosterone are becoming more common. Testosterone is used primarily to treat symptoms of sexual dysfunction in men and women and hot flashes in women. Potential benefits include improved libido, increased bone mass, and increased sense of well-being. In individuals with human immunodeficiency virus infection or other chronic diseases, testosterone has been shown to improve mood and energy levels, even in patients with normal testosterone levels. Testosterone can be administered by injection, patch, topical gel, pill, or implant. Side effects in men include polycythemia and acne. Side effects in women include acne, hepatotoxicity, and virilization and usually only occur when testosterone is used in supraphysiologic doses. Long-term studies of the effects of testosterone on prostate cancer, breast cancer, and heart disease have not been completed. Mammograms and monitoring of prostate-specific antigen, hematocrit, and lipid levels are recommended for patients taking testosterone.

In the United States, approximately 43 percent of women and 31 percent of men experience sexual dysfunction.1 It is not surprising that testosterone, primarily used to treat sexual problems, is being prescribed more often than in the past; a 500 percent increase in sales has been documented from 1993 to 2001.2 However, testosterone therapy is controversial, particularly for use in women. The safety and effectiveness of testosterone supplementation have not been clearly defined, although there is an extensive review3 by the Institute of Medicine outlining what is known about testosterone therapy in older men.

View/Print Table SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Evidence rating References Testosterone supplementation should be considered when treating sexual dysfunction in hypogonadal men. B 10–13 Testosterone combined with estrogen can improve sexual function and bone density in women, but is not FDA approved for this purpose. B 32,43,45–48 Men with human immunodeficiency virus infection or acquired immunodeficiency syndrome; who also have diminished mood, strength, libido, and well-being; often benefit from testosterone use. B 21–24 Until more consistent data are available, testosterone should be used with caution and only for those indications approved by the FDA. C 3 SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Evidence rating References Testosterone supplementation should be considered when treating sexual dysfunction in hypogonadal men. B 10–13 Testosterone combined with estrogen can improve sexual function and bone density in women, but is not FDA approved for this purpose. B 32,43,45–48 Men with human immunodeficiency virus infection or acquired immunodeficiency syndrome; who also have diminished mood, strength, libido, and well-being; often benefit from testosterone use. B 21–24 Until more consistent data are available, testosterone should be used with caution and only for those indications approved by the FDA. C 3