Sexual dysfunction is common among postmenopausal women and include a spectrum of problems, including low (or hypoactive) sexual desire, decreased satisfaction, and discomfort.   Reports indicate that the prevalence of hypoactive sexual desire ranges from 9% in naturally postmenopausal women up to 26% in younger surgically postmenopausal women.   A recent study published in the New England Journal of Medicine evaluates the effectiveness of the testosterone patch for postmenopausal women with low sexual desire.

814 postmenopausal women diagnosed with hypoactive sexual desire participated in this study and were recruited from 65 centers across the United States, Canada, Australia, and the United Kingdom.  None of the women were taking estrogen replacement therapy or any other type of hormonal treatment.  Participants were randomized to one of three groups:  treatment with a high-dose testosterone patch (300 µg per day), a low-dose testosterone patch (150 µg per day), or a placebo patch.

After 24 weeks of treatment, the group receiving the higher dose of testosterone were more likely to report improvement in the frequency of sexually satisfying episodes than those receiving the placebo.  The group receiving the lower does (150 µg per day) did not show any sign of improvement.  Compared to placebo, both doses of testosterone were associated with significant increases in desire and decreases in distress.  Adverse events – for example, unwanted hair growth – were more common in the group receiving the higher dose of testosterone than in the placebo group (30.0% vs. 23.1%).

This study is consistent with previous findings indicating that testosterone has positive effects on sexual functioning and that higher doses show greater improvement.  While these results suggest that testosterone may be helpful in women with hypoactive sexual desire, the authors note that the long-term effects of treatment with testosterone are unknown.  In this study, breast cancer was diagnosed in four women who received testosterone treatment; no cases were reported in the women receiving placebo.  It was noted that one of the four was diagnosed within the first 4 months of treatment, and one, in retrospect, had symptoms before entering into the study.  Thus, testosterone should be used with caution.

Ruta Nonacs, MD PhD

Leiblum SR, Koochaki PE, Rodenberg CA, Barton IP, Rosen RC. Hypoactive sexual desire disorder in postmenopausal women: US results from the Women’s International Study of Health and Sexuality (WISHeS). Menopause. 2006 Jan-Feb;13(1):46-56.

Davis SR, Moreau M, Kroll R, et al. Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen.  New England Journal of Medicine 2008; 359(19):2005-2017.

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