A survey of Brazilian gynecologists’ prescribing practices and attitudes toward testosterone use in women

Objectives: Evaluate gynecologists’ knowledge regarding the indications and attitudes toward testosterone therapy (TT). Methods: Cross-sectional survey with an 18-question questionnaire covering TT indications, routes, and doses usually prescribed for women. The questionnaire was answered by 1,213 out of the 6,000 gynecologists (20.2%) from the Brazilian Federation of Gynecology and Obstetrics online or on tablets during the 62nd Brazilian Congress of Gynecology and Obstetrics in 2025. Results: Of the sample, 58.9% were aged 31-49, 70.6% were women, 59.20% had 10 or more years since medical school graduation, and 98.4% had completed residency. Ninety-five percent sometimes prescribed TT for hypoactive sexual desire disorder, 85.5% for other indications, 93.9% sometimes for perimenopausal or postmenopausal women, 90.1% sometimes for premenopausal women, and 66% agreed or partially agreed to prescribe for breast cancer patients. The treatment was based on low testosterone levels, always or sometimes, for 90.1%. About 85.6% of gynecologists aimed for TT to reach the reference range for premenopausal women, and 91.2% believed adverse effects sometimes occurred. Of the total, 93.9% prescribed TT using compounded gels or creams, 54.9% implants, 38% used gels for males, 28.5% used oral forms, 28.3% used injections, and 10% used testosterone implants. In total, 78.1% believed treatment should last up to 6 months, 69.3% thought informed consent should be obtained, and 72% believed there should be an approved TT treatment for women. Conclusions: Brazilian gynecologists widely prescribe TT for various indications, relying heavily on compounded and unapproved formulations. This practice highlights a critical need for using correct routes of testosterone to avoid supraphysiological levels and the availability of approved, standardized TT options for women.