madman
Super Moderator
Start low and go slow, where have we heard that one before LOL!
Testosterone replacement therapy (TRT) in women may offer multidimensional symptom improvement extending beyond sexual function, according to Melissa Loseke, DO, Medical Director, Joi+Blokes, Omaha, Nebraska, highlighting findings from a retrospective study published in Personalized Medicine.
“From a general categorical perspective, beyond sexual function, which I think is what a lot of people think of when we start talking testosterone… across 8 domains, we really saw some improvements. Energy and mood, which were 2 of the biggest ones, which can include depression and irritability, obviously the sexual interest, focus, and concentration, which leads to memory improvements as well, which also can lead to overall quality of life improvements, but also saw some improvements from a cardiometabolic standpoint, with a decline in the triglyceride levels,” said Loseke.
“Yes, libido is a concern, but most of them just want to feel like themselves again. They want to have the energy to be present in their life, be the mom, be the wife, be the individual that they feel like they used to be,” Loseke said. “So, for them, it's really about reclaiming their vitality again, and if libido improves along that way, then that's a spectacular bonus for most of them.”
Biomarker data from a subset of patients showed favorable changes, including increases in total testosterone (+151.8%; d = 3.60) and free testosterone (+216.7%; d = 3.01), along with reductions in sex hormone–binding globulin (−13.3%; d = 1.57) and triglycerides (−12.6%; d = 1.28), supporting a physiologic response to therapy.
Loseke emphasized the importance of individualized dosing and monitoring.
“Generally speaking, these are women who had tried other methods for their symptoms who ended up on testosterone for their symptoms,” she said. “If we're going to start on testosterone, it's always going to be a start low, go slow from a side effect perspective.”
She noted that symptom response varies in timing. “I would rather have slow, systematic improvements for them, and I'll also tell them, ‘yes, we saw that the cognitive stuff tends to improve more down the road,”’' Loseke said. “I tell every [patient] to plan on 3 to 6 months, and optimally we're going to be talking 12 to 18 months [until] we find [the] ideal steady state.”
Despite encouraging findings, important study limitations may affect interpretation and generalizability. The retrospective, single-arm design and telehealth-based recruitment model introduce selection bias, as “participants were drawn from a single telehealth-based platform serving women who had already initiated and remained in TRT-based clinical care,” the authors noted.
Adverse events were not systematically assessed, precluding characterization of side effect profiles, including known androgenic effects such as acne, hirsutism, and voice changes. The absence of individual-level linkage between biomarker changes and symptom outcomes also prevented correlation analyses, limiting insight into mechanistic relationships. Further, the individualized, biomarker-guided dosing approach differs from fixed-dose regimens used in randomized trials, making comparisons to existing evidence challenging.
“That’s where I would really pause for some caution, just to not tie to causation,” Loseke said related to the improved cardiometabolic biomarkers. “Is it because they had more energy, they were able to work out more, they were able to gain more lean muscle mass, which improved their metabolic rate, which is going to improve triglycerides? I think it's just looking at that bigger picture of what kind of quality of life are you giving the female when you put her on some testosterone to improve her motivation for exercise, increase her ability for lean muscle mass that can then provide those improvements from a cardiometabolic standpoint.”
“I definitely think that labs are key,” Loseke added. “It is, number one, just making sure that you're following biomarkers as well as symptom improvement with the [patients], and making sure that the education is there so that you feel comfortable in your prescribing and understanding all the different options from a testosterone perspective.”
Testosterone replacement therapy (TRT) in women may offer multidimensional symptom improvement extending beyond sexual function, according to Melissa Loseke, DO, Medical Director, Joi+Blokes, Omaha, Nebraska, highlighting findings from a retrospective study published in Personalized Medicine.
“From a general categorical perspective, beyond sexual function, which I think is what a lot of people think of when we start talking testosterone… across 8 domains, we really saw some improvements. Energy and mood, which were 2 of the biggest ones, which can include depression and irritability, obviously the sexual interest, focus, and concentration, which leads to memory improvements as well, which also can lead to overall quality of life improvements, but also saw some improvements from a cardiometabolic standpoint, with a decline in the triglyceride levels,” said Loseke.
Testosterone beyond sexual function
The study of 332 women demonstrated improvements across 8 symptom domains, with the greatest gains reported in energy/fatigue (84.3%), followed by mood-related symptoms and sexual interest (>65%). Quality of life improvement was reported by 89.7% of patients, with significant improvement rising from 5.4% at 1 month to 51.5% at longer than 12 months, according to the study authors.“Yes, libido is a concern, but most of them just want to feel like themselves again. They want to have the energy to be present in their life, be the mom, be the wife, be the individual that they feel like they used to be,” Loseke said. “So, for them, it's really about reclaiming their vitality again, and if libido improves along that way, then that's a spectacular bonus for most of them.”
Biomarker data from a subset of patients showed favorable changes, including increases in total testosterone (+151.8%; d = 3.60) and free testosterone (+216.7%; d = 3.01), along with reductions in sex hormone–binding globulin (−13.3%; d = 1.57) and triglycerides (−12.6%; d = 1.28), supporting a physiologic response to therapy.
Loseke emphasized the importance of individualized dosing and monitoring.
“Generally speaking, these are women who had tried other methods for their symptoms who ended up on testosterone for their symptoms,” she said. “If we're going to start on testosterone, it's always going to be a start low, go slow from a side effect perspective.”
She noted that symptom response varies in timing. “I would rather have slow, systematic improvements for them, and I'll also tell them, ‘yes, we saw that the cognitive stuff tends to improve more down the road,”’' Loseke said. “I tell every [patient] to plan on 3 to 6 months, and optimally we're going to be talking 12 to 18 months [until] we find [the] ideal steady state.”
Despite encouraging findings, important study limitations may affect interpretation and generalizability. The retrospective, single-arm design and telehealth-based recruitment model introduce selection bias, as “participants were drawn from a single telehealth-based platform serving women who had already initiated and remained in TRT-based clinical care,” the authors noted.
Adverse events were not systematically assessed, precluding characterization of side effect profiles, including known androgenic effects such as acne, hirsutism, and voice changes. The absence of individual-level linkage between biomarker changes and symptom outcomes also prevented correlation analyses, limiting insight into mechanistic relationships. Further, the individualized, biomarker-guided dosing approach differs from fixed-dose regimens used in randomized trials, making comparisons to existing evidence challenging.
“That’s where I would really pause for some caution, just to not tie to causation,” Loseke said related to the improved cardiometabolic biomarkers. “Is it because they had more energy, they were able to work out more, they were able to gain more lean muscle mass, which improved their metabolic rate, which is going to improve triglycerides? I think it's just looking at that bigger picture of what kind of quality of life are you giving the female when you put her on some testosterone to improve her motivation for exercise, increase her ability for lean muscle mass that can then provide those improvements from a cardiometabolic standpoint.”
“I definitely think that labs are key,” Loseke added. “It is, number one, just making sure that you're following biomarkers as well as symptom improvement with the [patients], and making sure that the education is there so that you feel comfortable in your prescribing and understanding all the different options from a testosterone perspective.”
