The role of testosterone in the management of hypoactive sexual desire disorder
in postmenopausal women.
Author(s): Krapf JM, Simon JA.
Affiliation(s): The George Washington University, 2150 Pennsylvania Ave, NW #6A429, Washington,
DC 20037, USA. jkrapf@gwu.edu
Publication date & source: 2009, Maturitas. , 63(3):213-9
At least 16 million women over the age of 50 currently experience low sexual
desire, with approximately 4 million women exhibiting hypoactive sexual desire
disorder (HSDD). Although early research established that testosterone therapy
improves sexual desire in postmenopausal women, safer and more efficacious
administration routes were explored. Large randomized, double-blinded
placebo-controlled studies demonstrate that transdermal testosterone improves
sexual function and activity in postmenopausal women with HSDD. Large
multi-center Phase III trials further confirm the positive effects of the
testosterone patch in the treatment of HSDD. More recent studies are exploring
the utility of testosterone gels. Based upon data from two recent clinical
relevance studies, physicians can be reassured that postmenopausal women with
HSDD report a meaningful benefit with testosterone therapy, and further, women
will only continue therapy if they experience a meaningful benefit. Although most
trials combined testosterone with estrogen/progesterone therapy, the recent
APHRODITE trial examined testosterone alone, showing increased sexual desire with
mild adverse events. Concerns regarding the long-term safety profile of
transdermal testosterone must be addressed before the FDA will approve a
testosterone product for women. Although some fear an increased risk of breast
cancer with exogenous testosterone administration, recent studies support the
idea that androgens can play a role in suppressing the proliferative effects of
estrogen and progesterone. Long-term safety data is now being collected and
analyzed and Phase III trials focusing on long-term risks are underway. In the
meantime, transdermal testosterone appears to be a safe and effective therapy for
postmenopausal women with HSDD [Swanson S, DeRogatis L, Snabes M, Simes S,
Zborowski J. Treatment of HSDD in surgically menopausal women: a newly initiated
Phase III, randomized, double-blind, placebo-controlled, multi-center study of
the safety and efficacy of LibiGel. Presented at the Annual Meeting of the
International Society for the Study of Women's Sexual Health, February 22-25,
Orlando, FL; 2007].
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