Introduction: Testosterone is the most abundant biologically active hormone across a woman’s lifespan.
Purpose: To evaluate the safety of using testosterone implants in women.
Materials and Methods: A narrative review of the available literature was conducted across several electronic databases (EMBASE, LILACS, Medline, Ovid, among others) using both free-text and standardized search terms, covering the period from 1940 to 2025. The outcomes assessed included androgenic adverse effects and safety in the metabolic, cardiovascular, endometrial, mammary, hematological, and mental health domains.
Results: Seventy-eight publications were included. Testosterone implants are available in different concentrations and provide sustained and prolonged, although uncontrolled, release for three to six months, producing supraphysiological peaks and wide variability in serum testosterone levels (299.36 ± 107.34 ng/dL), along with substantial interindividual variance (35.9%) and a heavy reliance on observational data. Safety reports originate mainly from records based on personal clinical practice and describe mild androgenic adverse effects and voice changes. Although some observations suggest a lower incidence of breast cancer, these findings come from cohorts without adequate adjustment for confounding factors; therefore, a causal relationship cannot be established. Evidence concerning cardiovascular, metabolic, and endometrial outcomes remains scarce and inconsistent.
Conclusions: The reported benefits of testosterone implants in women remain hypothetical in light of the published studies, and their safety has not been confirmed. In the absence of well-designed and rigorously conducted randomized clinical trials, testosterone implants should not be used in women.
International Journal of Clinical Obstetrics and Gynaecology
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