Testosterone Beneficial for Sexual Function in Postmenopausal Women

Anti-tobacco patch or transdermal patch containing oestradiol (hormone replacement therapy HRT).
Testosterone therapy has been found to improve sexual function in postmenopausal women, but the lack of approved formulations for women in any country remains a major barrier to treatment.

Testosterone treatment significantly improves sexual function with relatively mild adverse effects in postmenopausal women with low sexual desire causing distress, according to study results published in The Lancet Diabetes & Endocrinology.

Researchers conducted a systematic review and meta-analysis of 46 publications from 36 randomized trials including 8480 women to determine whether testosterone treatment via various administration methods is safe and efficacious in the long term. Included studies were at least 12 weeks in duration for testosterone treatment, and patients received varying doses of testosterone orally (15 trials) or non-orally with transdermal patches (13 trials) or other applications (eg, creams, gels, sprays).

Primary outcomes included effects of treatment on sexual function, cardiometabolic variables, cognitive measures, and musculoskeletal health.

Compared with placebo or comparators such as estrogen, testosterone treatment significantly increased satisfactory sexual event frequency (mean difference, 0.82), sexual desire (mean difference, 0.36), pleasure (mean difference, 6.86), arousal (mean difference, 0.28), orgasm (mean difference, 0.25), responsiveness (mean difference, 0.28), and self-image (mean difference, 5.64). It also resulted in reduced sexual concerns (mean difference, 8.99) and personal sexual distress (mean difference, -0.27).

Regarding cardiometabolics, oral testosterone yielded a significant increase in low-density lipoprotein cholesterol and reductions in total cholesterol, high-density lipoprotein cholesterol, and triglycerides. However, these effects did not occur when testosterone was administered non-orally. There was an overall increase in weight from all testosterone treatments, but testosterone did not show any effects on body composition, musculoskeletal health, or cognitive measures, although data were minimal for these outcomes.

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Greater acne and hair growth were more common in patients who received testosterone (risk ratios, 1.46 and 1.69, respectively) compared with placebo or a comparator, but frequency of other adverse events did not differ between groups, including serious adverse events like endometrial and breast effects.

Several limitations were noted for this study, including attrition bias.

Although the reviewers acknowledged the added value of their study, they stated that the “absence of any approved testosterone formulations for women in any country, however, is a major treatment barrier. This shortfall urgently needs to be addressed to eradicate the widespread practice of women being treated with male formulations and compounded products, resulting in testosterone concentrations several fold greater than appropriate for women.”

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Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data [published online July 25, 2019]. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(19)30189-5