Engy Habashy, MD, on the role of androgens in GSM management

In this video, Engy Habashy, MD, discusses key clinical considerations from the 2025 AUA/SUFU/AUGS genitourinary syndrome of menopause (GSM) guideline, including the role of urologists in managing GSM and emerging perspectives on androgen-based therapies. This interview took place at the 27th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America in Orlando, Florida. Habashy is a urologist at Genesis Healthcare System in Columbus, Ohio.

Habashy emphasizes the importance of recognizing GSM as a contributor to lower urinary tract symptoms, including urgency, frequency, nocturia, overactive bladder, and recurrent urinary tract infections (UTIs). She explains that effective management requires understanding the underlying hormonal changes that affect the bladder, urethra, and female genital tissues during perimenopause and postmenopause. By addressing the pathophysiology of these symptoms, urologists can better identify and treat the conditions affecting their patients.

“It's really impossible to treat the pathology without understanding and addressing the pathophysiology,” Habashy noted.

The discussion also explores the role of estrogen and androgens in maintaining the health and function of the lower urinary and genital tracts. Habashy notes that low-dose vaginal estrogen can help restore tissue health, while androgen receptors are abundant in structures such as the vestibule, clitoris, and labia. She highlights the potential role of androgen-based approaches in addressing hormonal changes associated with menopause, noting that although FDA-approved vaginal estrogen formulations and dehydroepiandrosterone (DHEA) inserts are available, there is currently no FDA-approved topical testosterone formulation specifically for women.

Looking ahead, Habashy points to ongoing advocacy for expanding treatment options for women experiencing GSM, including the development of topical testosterone formulations for female use. She underscores the importance of recognizing the complementary roles of estrogen and androgens in managing menopausal changes and the potential for further research and regulatory developments to broaden the available therapeutic options.