Low doses of testosterone may improve sexual function and desire in postmenopausal women

Islam RM, Bell RJ, Green S, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019;7:754-66.

Review questions

Does treatment with testosterone improve sexual function In women? Does it affect body weight or cholesterol levels?

Background

Women sometimes have problems with sexual functioning. Problems can include low levels of desire or arousal, pain when having sex, or difficulty having orgasm. These may be more likely to happen after menopause but can happen for many reasons at any time of life. When these problems don’t go away, keep coming back, or cause distress, they may be considered sexual dysfunction. Women who are worried or upset about changes in their sexual functioning should talk to their doctor. This review looks at whether one treatment, testosterone, can improve symptoms of sexual dysfunction in women.

How the review was done

The researchers did a systematic review of studies available up to December 2018. They found 36 randomized controlled trials that included 8,480 adult women. Most women had gone through menopause, either naturally or because of surgery.

The key features of the studies were:

• testosterone was mostly given orally (in combination with other hormone therapies) or using a skin patch; it was also given in the form of a cream, gel, spray, or intramuscular injection;
• testosterone was given in low doses (mostly 1.25 to 2.5 mg/day orally or 300 µg daily or twice weekly with skin patches) and compared with placebo or other hormone therapies; and
• most women were treated for about 4 to 6 months (range 12 weeks to 2 years).

What the researchers found

Compared with placebo or other hormone therapies, testosterone:

• increased sexual function and desire by a small amount;
• increased low-density lipoprotein cholesterol (the type of cholesterol that increases the risk for heart disease) when given orally;
• increased body weight by about 0.5 kg; and
• increased risk for acne and extra hair growth.

Conclusions

In postmenopausal women, testosterone may improve sexual function and desire by a small amount compared with placebo or other hormone therapies. Testosterone can worsen some cholesterol levels when given orally, and it also increases body weight. We need more studies using low doses of testosterone to be confident about its effects. (Testosterone doses currently available in most countries are intended for men and are too high for women.)

Testosterone vs control (placebo or other hormone therapies) in postmenopausal women

LDL-C = low-density lipoprotein cholesterol.