Testosterone May Be Option for Low Sexual Desire in Women

Testosterone is effective for treating postmenopausal women who have low sexual desire that causes distress, a meta-analysis in The Lancet Diabetes & Endocrinology has found. The report also found that oral, but not transdermal, testosterone significantly increased LDL cholesterol, thus signaling that patches and gels would be better options for these patients.

Currently no testosterone formulations are approved specifically for women. Instead, physicians prescribe products designed for men or prescribe formulations to be made at compounding pharmacies. There is a need for clarity in understanding how different formulations and doses may affect women, said lead author Susan R. Davis, M.B.B.S., Ph.D., president of the International Menopause Society and director of the Women’s Health Research Program at Monash University in Melbourne.

“We did the study because there is quite widespread use of testosterone in women globally, with some doctors prescribing supra-physiological doses. A robust systematic review and meta-analysis was needed to inform practice, including evaluation of the available safety data,” Davis told Psychiatric News.

In their meta-analysis, Davis and her colleagues reviewed 46 reports of 36 trials involving 8,480 women aged 18 to 75. The trials were completed between January 1990 and December 2018 and assessed the effects of testosterone on sexual function, cardiometabolic variables such as lipids and weight, cognitive performance, and musculoskeletal health. Secondary outcomes in the trials included serious adverse events, mood and well being, and masculinizing effects such as deepening voice. The meta-analysis showed that in comparison with placebo or a comparator such as estrogen, testosterone significantly increased the number of satisfactory sexual encounters in postmenopausal women. Additionally, testosterone augmented sexual desire, pleasure, arousal, and orgasm and reduced sexual concerns and distress in these women. The only benefit for premenopausal women was a reduction in sexually associated personal distress, shown in one small study.

“The dearth of data pertaining to premenopausal women means no conclusions can be drawn about the efficacy of testosterone treatment for sexual dysfunction in this population,” Davis and her colleagues wrote.

Overall, testosterone was associated with weight gain, musculoskeletal health, or cognitive performance. Compared with placebo and estrogen, oral testosterone was associated with lowered total cholesterol and triglycerides, but appeared to raise LDL cholesterol and lower HDL cholesterol. Transdermal patches and creams were not associated with these effects.

“This study really highlights that presently, the only indication for testosterone in women is hypoactive sexual desire disorder [female sexual interest/arousal disorder]. Future research may show other benefits,” Davis said.

Davis noted that one study in the meta-analysis found that testosterone was an effective treatment for women whose low sexual desire was associated with selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).

“Psychiatrists should consider adding in testosterone if [female patients] need to continue their SSRI/SNRI rather than the patients having to cease the antidepressant they might need,” Davis said.

Anita H. Clayton, M.D., David C. Wilson Professor and chair of the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia, encouraged psychiatrists to consider possible modifiable factors affecting low desire and sexual dysfunction before prescribing any medication. Clayton was not involved in the research.

“Make sure the patient doesn’t have another condition like thyroid dysfunction, diabetes, or postsurgical problems [from surgical menopause], and that a medication or substance is not the cause of the distressing low sexual desire,” said Clayton.

Clayton urged caution in prescribing testosterone for premenopausal women because of the potential impact on the fetus in the event of pregnancy, and she pointed out that the findings from this meta-analysis do not support use in premenopausal women. For female patients who are prescribed testosterone, she advised against doses higher than what is normally found in the body.

“Women may feel that [a high dose] gives them vitality. That’s problematic in that it can cause other problems like male hair growth, clitoromegaly, or voice deepening. We need to check testosterone levels and monitor them over time to ensure they are not too high,” Clayton said.

This study was supported by the Australian National Health and Medical Research Council. ■

“Safety and Efficacy of Testosterone for Women: A Systematic Review and Meta-Analysis of Randomised Controlled Trial Data” is posted here.