Testosterone Replacement Therapy Effects in Women

Effects on Body Composition

Women with HIV wasting have low testosterone levels, but testosterone supplementation shows some positive effects on muscle mass strength without significant weight gain or muscle mass gain 1, 2, 3
A meta-analysis of testosterone therapy in HIV patients showed only a minimal difference in weight between testosterone and placebo groups, indicating minimal impact on overall weight 1, 2

Testosterone replacement is associated with weight loss and improvements in metabolic parameters in men with obesity and hypogonadism, which may inform expectations in women 4, 5

Testosterone therapy is not currently licensed for use in HIV wasting in women in Europe, and there are concerns about adverse metabolic effects of long-term testosterone administration in women 1, 2
Testosterone assessment should be considered in patients with signs and symptoms of hypogonadism, including decreased energy, libido, and muscle mass 4, 6
Monitoring should include testosterone levels 2-3 months after treatment initiation and after any dose change 6
The method of testosterone replacement should be selected based on individual patient factors, with transdermal preparations often preferred for convenience 6
The Endocrine Society recommends careful monitoring of patients on testosterone therapy, considering the potential risks and benefits 6
Testosterone therapy in transgender men leads to significant increases in muscle volume, quadriceps cross-sectional area, and muscle strength, which may be relevant when considering effects in cisgender women 7

In a meta‑analysis of randomized controlled trials evaluating testosterone therapy versus placebo in women, the pooled mean difference in total body weight was 1.04 kg (95 % CI 0.01–12.10 kg) favoring testosterone, indicating only a trivial increase in weight that was not clinically significant【8】.

Strength of evidence: moderate (meta‑analysis of RCTs).