Testosterone therapy in women: a review

Female sexual dysfunction is a complex problem with multiple overlapping etiologies. Androgens play an important role in healthy female sexual function, especially in stimulating sexual interest and in maintaining desire. There are a multitude of reasons why women can have low androgen levels with the most common reasons being age, oophorectomy and the use of oral estrogens. Symptoms of androgen insufficiency include absent or greatly diminished sexual motivation and/or desire, that is, libido, persistent unexplainable fatigue or lack of energy, and a lack of sense of well being. Although there is no androgen preparation that has been specifically approved by the FDA for the treatment of Women's Sexual Interest/Desire Disorder or for the treatment of androgen insufficiency in women, androgen therapy has been used off-label to treat low libido and sexual dysfunction in women for over 40y. Most clinical trials in postmenopausal women with loss of libido have demonstrated that the addition of testosterone to estrogen significantly improved multiple facets of sexual functioning including libido and sexual desire, arousal, frequency and satisfaction. In controlled clinical trials of up to 2y duration of testosterone therapy, women receiving androgen therapy tolerated androgen administration well and demonstrated no serious side effects. The results of these trials suggest that testosterone therapy in the low-dose regimens is efficacious for the treatment of Women's Sexual Interest and Desire Disorder in postmenopausal women who are adequately estrogenized. Based on the evidence of current studies, it is reasonable to consider testosterone therapy for a symptomatic androgen-deficient woman with Women's Sexual Interest and Desire Disorder.