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Grand Rounds

Does Testosterone Treatment Improve Sexual Function in Women?

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BACKGROUND AND PURPOSE:

  • While testosterone treatment for the improvement of low sexual desire in women is common, data on safety is limited
  • Islam et al. (The Lancet Diabetes & Endocrinology, 2019) sought to determine the potential benefits and risks of testosterone treatment for women

METHODS:

  • Systematic review and meta-analysis
  • Data sources
    • MEDLINE, Embase, the Cochrane Central Register of RCTs and Web of Jan 1, 1990, and Dec 10, 2018
    • Drug registration applications to the European Medicine Agency and FDA was also searched for unpublished data
  • Inclusion criteria
    • Blinded RCTs (minimum single blinded)
    • Duration of testosterone treatment ≥12 weeks
  • Participants
    • Women 18 to 75 years of age
    • Premenopausal or postmenopausal (natural or surgical)
    • With or without concurrent hormone treatment
    • Intravaginal testosterone excluded
  • Primary outcomes: the effects of testosterone on
    • Sexual function
    • Cardiometabolic variables
    • Cognitive measures
    • Musculoskeletal health

RESULTS:

  • 36 RCTs | 8480 patients | Most studies appropriately excluded women with identifiable causes that should be treated with other options, and not testosterone (e.g., depression or anti-depressant use)
  • Compared with placebo or a comparator (e.g., estrogen, with or without progestogen), testosterone significantly increased sexual function in postmenopausal women
    • Satisfactory sexual event frequency: Mean difference 0.85 (95% CI, 0.52 to 1.18)
    • Sexual desire: Standardized mean difference 0.36 (95% CI, 0.22 to 0.50)
    • Pleasure: Mean difference 6.86 (95% CI, 5.19 to 8.52)
    • Arousal: Standardized mean difference 0.28 (95% CI, 0.21 to 0.35)
    • Orgasm: Standardized mean difference 025 (95% CI, 0.18 to 0.32)
    • Responsiveness: Standardized mean difference 0.28 (95% CI, 0.21 to 0.35)
    • Self-image: Mean difference 5.64 (95% CI, 4.03 to 7.26)

Note: Data limited for premenopausal women and conclusions could not be drawn

  • Compared with placebo or a comparator testosterone significantly reduced the following in postmenopausal women
    • Sexual concerns: Mean difference 8.99 (95% CI, 6.90 to 11.08)
    • Distress: Standardized mean difference −0.27 (95% CI, −0.36 to −0.17)
  • Comparing oral testosterone to non-oral (e.g., transdermal patch or cream) for postmenopausal women
    • LDL-cholesterol levels increased
    • Total cholesterol decreased
    • HDL-cholesterol decreased
    • Triglycerides decreased
  • Testosterone treatment was associated with an increase in weight in postmenopausal women
    • Weight gain mean difference 0.48 (95% CI, 0.16 to 0.79)
  • No effects of testosterone were seen for the following (authors caution small ‘n’)
    • Body composition | Musculoskeletal variables | Cognitive measures
  • Adverse events
    • Compared to placebo or comparator, testosterone was significantly associated with greater likelihood of reporting
      • Acne: Relative risk (RR) 1.46 (95% CI, 1.11o 1.92)
      • Hair growth: RR 1.69 (95% CI, 1.33 to 2.14)
    • There were no reported serious events such as alopecia or voice change

CONCLUSION:

  • Testosterone treatment is effective for improving sexual function in postmenopausal women
  • Non-oral route appears to have a superior lipid profile
  • More long-term studies are needed
  • The authors call for approved testosterone formulations, specifically for women and further state

Our comprehensive systematic review provides robust support for a trial of testosterone treatment, using a dose appropriate for women, when clinically indicated in postmenopausal women

Learn More – Primary Sources:

Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data

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Related ObG Topics:

Testosterone Therapy for Low Desire – How, When and Where?
Treatment Options for the Patient with Low Sexual Desire
KEEPS Trial: What Are the Effects of Oral vs Transdermal Estrogen Therapy on Sexual Function?
What role does sleep disturbance play in sexual dysfunction?

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