Premenopausal women suffering from sexual dysfunction and a low libido don’t have many options for treatment, and a recent study suggests that, while testosterone replacement therapy is often used, there is no evidence to prove its efficacy.
Meanwhile, a survey of urologists and other clinicians found that most physicians recognized an association between libido and testosterone levels in women, but less than half would prescribe testosterone to premenopausal women with low libido.
In a new systematic review on the use of testosterone as a treatment option for premenopausal women with low libido, researchers at the University of Texas Southwestern Medical Center, Dallas say there is little value in testing women’s testosterone levels, and that replacement therapy is unproven and could cause unwanted side effects.
The report, published in the International Journal of Women’s Health (2016; 8:599-607), reviewed 13 research studies and clinical trials conducted between 1995 and 2015. Six out of the 10 testosterone serum evaluation studies showed no significant association between serum testosterone levels and libido, and only one of the four studies examining an intermediate-level testosterone treatment in this population resulted in any improvement in libido.
Forty percent of women in the United States experience self-reported sexual dysfunction, according to the paper, and low libido was the most common complaint. Testosterone is frequently prescribed as an off-label treatment option because there is only one medication—a selective serotonin reuptake inhibitor called flibanserin (Addyi)—approved for this use by the FDA. Testosterone seems like a logical treatment for women, given the long-standing hypotheses about the role of the hormone in female libido, according to the report, but the physiologic role of testosterone in women has not been clearly defined to date.