Cortisol and Testosterone Interaction in Clinical Management

Clinical Implications

• In patients with adrenal insufficiency requiring cortisol replacement, testosterone levels may be affected, according to the American Society of Clinical Oncology 1, 2
• DHEA replacement may be considered in women with low libido and/or energy who are otherwise well-replaced with cortisol, as DHEA is a precursor to testosterone, as suggested by the American Society of Clinical Oncology 2, 3

Clinical Management Considerations

• When treating patients with cortisol replacement therapy, clinicians should be aware of potential impacts on testosterone levels, as recommended by the American Society of Clinical Oncology 1, 4
• In patients with hypophysitis affecting both adrenal and gonadal axes, corticosteroid replacement should be initiated before testosterone replacement to avoid precipitating adrenal crisis, according to the American Society of Clinical Oncology and the European Society for Medical Oncology 5, 6
• Testosterone or estrogen therapy may be needed in patients with central adrenal insufficiency who don't have contraindications, as suggested by the American Society of Clinical Oncology and the European Society for Medical Oncology 5, 7