Testosterone Supplementation for Hypoactive Sexual Desire Disorder in Women

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.

Association of testosterone with estrogen abolishes the beneficial effects of estrogen treatment by increasing ROS generation in aorta endothelial cells

“…The benefits of testosterone therapy to treat female sexual dysfunction have been reported for decades and have been strengthened by recent randomized controlled data supporting its use (48). Similar to estrogens, testosterone exerts wideranging and concentration-specific effects via interaction with specific receptors found throughout the body, including the vascular wall (30).…”

Sexual Function Across Aging

“…In a study by Sherwin et al, 54 surgically postmenopausal women were given testosterone 220-mg injections or estrogen 10 mg or a combination of testosterone 150 mg with estrogen 8.5 mg or placebo monthly for 3 months; the groups receiving testosterone supplementation had significantly increased desire, arousal, and fantasies compared to the groups not receiving testosterone [43,44].…”

Female sexual dysfunction: a focus on flibanserin

“…These agents include testosterone, bupropion, sildenafil, melanocortin receptor agonists and the use of complementary products such as dehydroepiandrosterone (DHEA); however, until recently, there were no FDA-approved options specifically for FSD. 7 , 16 – 23 Flibanserin is now the first FDA-approved pharmacologic option for low sexual desire or HSDD. Flibanserin focuses on the role of neurotransmitters within the sexual response.…”

“…Neurotransmitters such as dopamine, norepinephrine and serotonin have involvement in a patient’s sexual response, with dopamine and norepinephrine providing an excitatory effect versus serotonin having an inhibitory effect. 7 , 8 Hormonal changes, associated with estrogen in naturally occurring or surgically induced menopausal patients, may also alter a patient’s sexual activity and interest. Specifically, estrogen reductions may increase vaginal dryness and dyspareunia, increasing the potential for sexual dysfunction.…”

“…This article focuses solely on key features regarding flibanserin, while the use of additional pharmacologic options investigated to treat FSD or low sexual desire is described in previous publications. 7 , 16 – 23 …”