Jessica Yih, MD, highlights data on testosterone therapy in women

In this video, Jessica M. Yih, MD, discusses findings from a systematic review examining the evidence for testosterone therapy in premenopausal and postmenopausal women with female sexual dysfunction.¹ Yih is an assistant professor of urology and the director of women's sexual health and male infertility at the University of California, Irvine.

According to Yih, the study originated out of a desire to characterize the available data on testosterone therapy in postmenopausal women given the current lack of guidance in this population.

“There's 1 guideline that has been endorsed by several international medical societies that discusses the use of testosterone therapy in women,“ she explained. “The guidelines essentially state that it is indicated for postmenopausal women with hypoactive sexual desire disorder or low libido that's distressing, so there is not a lot of data about whether it is useful for premenopausal women.”

The current review included 33 studies identified through searches of Scopus, PubMed, and CINAHL. Among these, 2 randomized controlled trials (RCTs) evaluated testosterone therapy in premenopausal women, compared with 7 RCTs in postmenopausal women.

Data showed that among premenopausal women, transdermal and vaginal testosterone were associated with improvements in libido, frequency of satisfactory sexual events, and sexual satisfaction. Sample sizes in these trials ranged from 31 to 261 participants, underscoring the more limited evidence base in this population.

The evidence was more robust among postmenopausal women, including large-scale RCTs demonstrating significant improvements in sexual desire and hypoactive sexual desire disorder symptoms with transdermal testosterone (300 μg/day). The efficacy benefits were consistent across studies, although there was inconsistent reporting regarding androgen levels and long-term safety data.

The authors concluded that testosterone therapy is effective for improving key aspects of sexual function in both premenopausal and postmenopausal women, but emphasized that the strength of evidence differs between the populations. They suggested that further high-quality studies are needed to establish optimal indications and dosing and to better characterize long-term safety of testosterone therapy in premenopausal women.

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