Publication Details
Abstract
Historically, androgens were regarded mainly as male sex hormones, although testosterone production by the ovaries and adrenal glands, and its peripheral conversion, play a physiological role in women. Since the late 1930s, attempts have been made to use androgens to treat gynecological and sexual complaints, but early interventions were based mainly on clinical observations. The 2002 Princeton consensus formulated the concept of female androgen insufficiency, whereas data accumulated later showed the absence of a reproducible biochemical threshold for such a syndrome. The aim of this review is to trace the evolution of ideas about androgens in peri- and postmenopause and to critically assess the diagnostic value of hormonal measurements and questionnaires, as well as the efficacy and safety of interventions, taking into account the 2025 recommendations of the International Menopause Society, a 2026 systematic review, and the scientific programme of the 20th World Congress on Menopause (Rio de Janeiro, 2026). The review addresses the physiology of ovarian–adrenal androgens, HSDD, the limitations of laboratory methods and psychometric instruments, the results of randomized trials, and the prospects of phenotyping. At present, the indication for a trial of transdermal testosterone with a convincing evidence base is clinically confirmed hypoactive sexual desire disorder in postmenopausal women after a biopsychosocial assessment; an isolated low testosterone level does not establish the diagnosis. Standardization of measurement methods, cultural adaptation of scales, and study of predictors of response and long-term safety are needed.