A systematic review of randomized controlled trials investigating the efficacy and safety of testosterone therapy for female sexual dysfunction in postmenopausal women

Abstract

Summary The clinical sequelae of oestrogen deficiency during menopause are undoubted. However, the pathophysiological role of testosterone during the menopause is less clear. Several randomized, placebo‐controlled clinical trials suggest that testosterone therapy improves sexual function in postmenopausal women. Some studies suggest that testosterone therapy has additional effects, which include increased bone mineral density and decreased serum high‐density lipoprotein (HDL) cholesterol. Furthermore, the long‐term safety profile of testosterone therapy in postmenopausal women is not clear. This article will provide a concise and critical summary of the literature, to guide clinicians treating postmenopausal women.

Cellular and Functional Physiopathology of Bull Sperm With Altered Sperm Freezability

“…Oxidative stress is a potential factor for poor fertility status with abnormal sperm parameters and indicates the imbalance between the overproduction of ROS and total antioxidant capacity in the cell. Oxidative stress gives rise to impaired sperm function by causing DNA damage, thus remains a challenging factor for male infertility and potential pregnancy losses (21)(22)(23). At the physiological concentrations, ROS is necessary for aerobic metabolism, membrane fluidity, and sperm fertilizing ability, while also critical for acrosome reaction and capacitation by modulating cAMP synthesis and tyrosine phosphorylation, and by signaling to support fertilization (24)(25)(26).…”

The Effectiveness of Psycho-Educational and Cognitive-Behavioral Counseling on Female Sexual Dysfunction

“…4,8 There are two general methods of pharmacological and nonpharmacological interventions to treat sexual disorders. 8,9 Nonpharmacological measures include cognitivebehavioral sex therapies, which are nowadays one of the most common approaches in the treatment of psychosexual and psychological disorders. 10,11 Cognitive-behavioral therapy (CBT) is a combination of cognitive and behavioral approaches that help the patient identify his distorted thinking patterns and inefficient behaviors.…”

Primary care use of testosterone therapy to benefit women experiencing distress related to decreased sexual desire after surgical menopause

“…Route. When it comes to prescription, some authors contend that testosterone may improve symptoms of sexual dysfunction regardless of route (Jayasena et al, 2019). The pros and cons of many of the available routes were presented in the reviewed literature and appear in the findings section, however, intravaginal testosterone was not discussed in the reviewed literature.…”

“…Intravaginal testosterone has been investigated in the treatment of vulvovaginal atrophy which can be accompanied by sexual dysfunction including decreased sexual desire (Bell, Rizvi, Islam, & Davis, 2018). Sexual desire was seen to improve, but it is unclear if this was due to sex steroid support of the local tissues, and a systematic review concludes that higher quality evidence, than what is currently published, is needed to establish efficacy and safety of intravaginal testosterone (Bell et al, 2018;Jayasena et al, 2019). Several clinical trials have evaluated a transdermal matrix patch, and many others have investigated transdermal creams and gels.…”

“…Due to limited clinical data, it remains unknown whether there is any increased risk of breast cancer, or other adverse effects, with longer-term testosterone therapy (Nachtigall et al, 2011). Although an increased risk of breast cancer has not been demonstrated, even in clinical trials up to 3 to 4 years in duration, the consensus in the literature remains that there is not enough evidence to rule out an increased risk (Al-Imari & Wolfman, 2012;Jayasena et al, 2019). Since cancer is often associated with long term exposure to cancer promoting compounds, if testosterone somehow promotes breast cancer, perhaps through aromatization to estrogen, then long-term testosterone therapy would imbue elevated risk.…”