Testosterone therapy for sexual dysfunction in postmenopausal women

Background After menopause, both surgical and natural, increases occur in the number of women experiencing sexual dysfunction. Although a direct link between sexual dysfunction and endogenous testosterone levels has not been clearly established, testosterone therapy is known to improve the signs and symptoms related to hypoactive sexual desire. However, testosterone supplementation is not approved in the United States for these clinical indications, primarily because of a lack of data evaluating the possible side-effects of these drugs. Method A MEDLINE search was performed, with a priority for well-designed studies (randomized, controlled trials, meta-analysis), for published data related to the efficacy and safety of testosterone therapy in postmenopausal women. Results Randomized trials have demonstrated an improvement in sexual function with testosterone in postmenopausal women with hypoactive sexual desire disorder, particularly after oophorectomies. Side-effects have been well tolerated and reversible upon discontinuation. Conclusion Exogenous testosterone treatment provides a rational therapeutic alternative to consider in women whose hypoactive sexual desire disorder negatively affects their quality of life and who have no biologic or psychosocial causes not related to decreased androgen levels for their sexual disorder. Women receiving testosterone should be monitored for clinical improvement and for adverse reactions. Transdermal patches and topical gels avoid the hepatic first-pass metabolism and are the preferred formulations. Testosterone therapy is usually administered concomitantly with estrogen therapy due to a lack of adequate safety and efficacy data on testosterone alone.