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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

Outcomes

Effects of testosterone

Sexual function

Increased number of satisfying sexual events by about 1 per month (8 trials with 3,238 women)

 

Small improvement in sexual desire (15 trials with 3,762 women), arousal (11 trials with 3,271 women), orgasm (11 trials with 3,289 women), responsiveness (8 trials with 3,212 women), and sexual distress (7 trials with 2,886 women)

 

Improved scores for pleasure (7 trials with 3,006 women), sexual self-image (7 trials with 2,997 women), and sexual concerns (7 trials with 3,009 women)

Cholesterol

Increased LDL-C levels (the type of cholesterol that increases risk for heart disease) when given orally (9 trials with 637 women)

 

No effect on LDL-C levels when not given orally (mainly using a patch or cream) (10 trials with 1,768 women)

Body weight

Increased weight by about 0.5 kg (5 trials with 2,032 women)

Adverse events

Increased risk for acne (10 trials with 3,264 women) and extra hair growth (11 trials with 4,178 women) but did not increase risk for alopecia (hair loss) (5 trials with 2,459 women), voice changes (5 trials with 2,587 women), enlarged clitoris (3 trials with 1,643 women), or serious adverse events (9 trials with 4,063 women)

LDL-C = low-density lipoprotein cholesterol.



Related Topics


Glossary

Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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