Testosterone Supplementation for Hypoactive Sexual Desire Disorder in Women

Abstract and Introduction

Abstract

Over 50% of women are believed to be affected by female sexual dysfunction (FSD). When particularly distressful, FSD is known as hypoactive sexual desire disorder (HSDD). In contrast to male sexual dysfunction that has been extensively researched, there is less evidence addressing the treatment of HSDD in women, particularly with regard to the use of androgen therapy. A variety of testosterone products, including oral, injectable, and transdermal preparations, has been prescribed for the treatment of HSDD in premenopausal women, as well as in those with naturally occurring or surgically induced menopause. Although studies have shown some benefit with testosterone supplementation in women with HSDD, conflicting evidence and debate regarding the clinical efficacy of testosterone remain. Because of concern over potential adverse events, additional studies with longer follow-up periods are necessary before use of testosterone in women with HSDD becomes widespread. Initiation of testosterone therapy must be considered on an individual basis after a thorough discussion with the patient about risks and benefits.

Introduction

Previous reports have estimated that by the year 2030, 1.2 billion women worldwide will be either menopausal or postmenopausal.^[1] Low libido has been a complaint routinely voiced by menopausal women, and current reports cite that 16 million women older than 50 years experience low sexual desire.^[2] Furthermore, female sexual dysfunction (FSD) is believed to affect over 50% of women.^[3] Female sexual dysfunction is a loss of desire for sexual activity that, in turn, causes significant distress and possible strain on interpersonal relationships. Diminished sexual arousal, dyspareunia, and difficulty achieving orgasm are also characteristics of FSD.^[4,5] Hypoactive sexual desire disorder (HSDD) is the most common form of FSD and is characterized by low sexual desire that has become particularly distressful; HSDD is believed to affect approximately 1 out of 10 adult women in the United States.^[6]

Historically, the treatment of male sexual dysfunction has been addressed and investigated, but pharmacotherapeutic treatment for FSD has been somewhat controversial, and supporting evidence has been limited. Several pharmacologic options with varying levels of evidence exist for the treatment of HSDD in women, and the use of supplemental testosterone in some women has shown benefit, particularly by improving desire, responsiveness, orgasm, arousal, and satisfaction.^[7]

Pharmacotherapy. 2012;32(1):38-53. © 2012  Pharmacotherapy Publications