(058) Clinical Practices in Testosterone Therapy Among ISSWSH Members

Abstract Introduction Testosterone therapy is increasingly prescribed for sexual health concerns in both men and women, yet evidence-based guidelines for women remain limited and inconsistently applied. According to current ISSWSH guidelines, the only evidence-based indication for testosterone therapy in women is the treatment of hypoactive sexual desire disorder (HSDD) in post-menopausal women. The guidelines also recommend measuring total testosterone levels before and during treatment, and discontinuing therapy after six months if symptoms do not improve. Despite these existing guidelines, gaps in evidence and clinical nuance often lead providers to individualize care beyond current recommendations and reflect the need for more comprehensive clinical guidance. Objective The purpose of this study is to characterize how clinicians with significant clinical practice in women’s health prescribe and manage testosterone therapy for women. Methods Licensed clinicians with 1 year of independent clinical practice who prescribe or manage testosterone therapy in women were invited to complete a 25-item, anonymous, 5-minute electronic survey distributed to them via email. The survey collected respondent demographics, practice patterns, factors influencing prescribing decisions, and adherence to existing guidelines. Results The survey response rate was 83% (15/18). All respondents were female licensed MD/DO (50%, N = 7), NP (35.7%, N-5), and PA (14.3%, N = 2). Respondents represented a variety of specialty backgrounds including gynecology (53.3%, N = 8) and urology (26.7%, N = 4). A majority of respondents have been providing testosterone therapy for women for 5 years (64.3%, N = 9) and the majority of clinicians prescribed therapy for HSDD (100%, N = 14), menopause (85.7%, N = 120), and vulvovaginal pain (78.6%, N = 11). Testosterone cream/gel, commercially available (85.7%, N = 120) or compounded (78.6%, N = 11), was the formulation prescribed by the majority of clinicians. Even though 100% of clinicians measure total testosterone before treatment, 57.1% (N = 8) prescribe therapy regardless of serum testosterone levels. For those who do use a threshold, the most common level was 20 ng/dL (50%, N = 7). 92.9% of respondents measure testosterone levels before, after, and during treatment, and 50% use 51-70 ng/dL as a target post-treatment total testosterone range. A majority of clinicians feel comfortable maintaining supratherapeutic testosterone levels (57.1%, N = 8); however, no clinicians felt comfortable maintaining testosterone above 250 ng/dL. The main barriers to care reported by clinicians was lack of standardized female formulations (85.7%, N = 12) and insurance limitations (71.4%, N = 10). Conclusions Among the licensed clinicians surveyed, there was variation in pre-treatment testosterone thresholds, post-treatment testosterone target ranges, and testosterone formulations prescribed. The majority of clinicians reported the lack of standardized female testosterone formulations and insurance limitations as barriers to care, highlighting the need for comprehensive guidelines that take into account these unique challenges. Disclosure No.