Testosterone therapy in women: a review

Abstract

Female sexual dysfunction is a complex problem with multiple overlapping etiologies. Androgens play an important role in healthy female sexual function, especially in stimulating sexual interest and in maintaining desire. There are a multitude of reasons why women can have low androgen levels with the most common reasons being age, oophorectomy and the use of oral estrogens. Symptoms of androgen insufficiency include absent or greatly diminished sexual motivation and/or desire, that is, libido, persistent unexplainable fatigue or lack of energy, and a lack of sense of well being. Although there is no androgen preparation that has been specifically approved by the FDA for the treatment of Women's Sexual Interest/Desire Disorder or for the treatment of androgen insufficiency in women, androgen therapy has been used off-label to treat low libido and sexual dysfunction in women for over 40 y. Most clinical trials in postmenopausal women with loss of libido have demonstrated that the addition of testosterone to estrogen significantly improved multiple facets of sexual functioning including libido and sexual desire, arousal, frequency and satisfaction. In controlled clinical trials of up to 2 y duration of testosterone therapy, women receiving androgen therapy tolerated androgen administration well and demonstrated no serious side effects. The results of these trials suggest that testosterone therapy in the low-dose regimens is efficacious for the treatment of Women's Sexual Interest and Desire Disorder in postmenopausal women who are adequately estrogenized. Based on the evidence of current studies, it is reasonable to consider testosterone therapy for a symptomatic androgen-deficient woman with Women's Sexual Interest and Desire Disorder.

Salivary testosterone: Associations with depression, anxiety disorders, and antidepressant use in a large cohort study

“…We also analyzed current psychiatric disorders within the preceding month for depressive disorder and anxiety disorders (i.e., social phobia, panic disorder and/or agoraphobia, and generalized anxiety disorder). The total score of the Inventory of Depressive Symptomatology Self Report (IDS-SR) was used to assess overall depression severity, [60] and subdivided into five severity groups, i.e., low (total score 0-13), mild (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), moderate (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38), severe (39)(40)(41)(42)(43)(44)(45)(46)(47)(48), and very severe . Item 22 (i.e., interest in sex) from the IDS-SR was analyzed separately as an internal validation of the salivary testosterone assessment, that was rated on a four-point scale: 0 (i.e., usual interest), 1 (i.e., somewhat less interest or pleasure), 2 (i.e., little interest or pleasure), and 3 (i.e., no interest or pleasure).…”

“…The brain contains receptors for testosterone [16][17][18][19], and is capable of synthesizing and metabolizing testosterone to, for instance, estradiol [20][21][22]. In some studies, a low androgen status has been associated with symptoms of fatigue, irritability, dysphoria, declining vigor, low vitality, sexual dysfunction in men [23][24][25][26] and women [27], and an increased risk of depressive symptoms and depression in most [28][29][30] but not all studies [31,32]. Findings were mixed, however, as several other epidemiological studies did not show or showed non-linear relationships between testosterone levels and depressive symptoms [33].…”

To study hypoactive sexual desire disorder in a fragile X carrier female successfully treated with local testosterone application

“…Most clinical trials in postmenopausal women with decreased interest in sexual activities have clearly demonstrated that the addition of testosterone to estrogen significantly improved multiple facets of sexual functioning, including libido, arousal, frequency and satisfaction. 2 No case reports have been published yet explaining the effect of testosterone in a fragile X carrier who behaves as a normal XX female, with few exceptions like premature ovarian failure, which is found in 28% of female fragile X premutation carriers. 3 We have tried to explain a one and one-half year followup in treating hypoactive sexual desire disorder with this disease.…”

“…There are a multitude of reasons why women can have low androgen levels, with the most common reasons being age, oophorectomy, hypothalamic-pituitary abnormalities, adrenal insufficiency, glucocorticoid therapy and the use of exogenous estrogens. 1,2 In a fragile X carrier state, oral contraceptive pills and premature ovarian failures can lead to low androgen levels. Symptoms of androgen insufficiency include absent or greatly diminished sexual motivation and/or desire (or libido), persistent unexplainable fatigue or lack of energy, and a lack of sense of well-being.…”

Determinants of making success in female Tree Swallows (Tachycineta Bicolor)

“…In addition, sexual behaviour of females may enhance the opportunity for engaging in extra-pair copulations; for example, during the fertile period, female humans (Homo sapiens) have greater desire or interest in extra-pair mates (e.g., Gangestad et al, 2002;Gangestad et al, 2005). Experimentally elevating T concentrations increases aggressive behaviour in female birds (Zysling et al, 2006;Sandell, 2007;Rosvall, 2013) and sexual interest, libido and behaviour in humans (reviewed in Bolour and Braunstein, 2005); however, studies investigating whether elevated T mediates extra-pair copulation behaviour in female birds have produced mixed results. T-treated female dark-eyed juncos (Junco hyemalis) did not differ from control females in the proportion of extra-pair offspring in their nests (Gerlach and Ketterson, 2013), whereas extra-pair paternity was lower for T-treated female spotless starlings (Sturnus unicolor) and blue tits (Cyanistes caeruleus) when compared to control females (García-Vigón et al, 2008;de Jong, 2013, respectively).…”