Tools for Practice Outils pour la pratique


#408 Testosterone for Women: Desire, data and downsides


CLINICAL QUESTION
QUESTION CLINIQUE
 Can testosterone improve sexual function in pre or post-menopausal women?

BOTTOM LINE
RÉSULTAT FINAL
 In post-menopausal women with hypoactive sexual desire disorder (mostly on estrogen therapy), testosterone improves the number of satisfying sexual events by ~1 more per month over placebo at 12-52 weeks. Absence of benefit in premenopausal women may be due to small study sizes. Versus placebo, testosterone increases risk of acne (7.2% versus 5%) and hirsutism (12% versus 8%).


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EVIDENCE
DONNÉES PROBANTES
  • Statistically different unless stated.
  • Four systematic reviews (7-35 RCTs, 1957-8480 women) comparing testosterone (various formulations) versus comparator.1-4 Focusing on most recent systematic reviews:1,2 Mostly post-menopausal women on hormone therapy, followed 12-104 weeks:
    • Satisfying sexual events:
      • Post-menopausal women:1 Baseline not reported. Testosterone increased by 0.85 events/month.
        • Example (baseline: ~2.5 events/month):5 At 6 months, 4.6 (testosterone 300ug patch) versus 3.2 (placebo) per month.
      • Pre-menopausal women (2 RCTs, 163 subjects):1 No difference (likely underpowered).
    • Orgasm: ~2 Per month versus 0.75 (placebo).2
    • Desire:1 Standard mean difference=0.36.
      • Example: (Scale 0-100, higher=more desire, baseline ~20). Testosterone increased to ~33 versus 26 (placebo).5
    • Personal distress:1 Standard mean difference=0.27.
      • Example: (Scale 0-100, lower=less distress, baseline: 65). Testosterone reduced to ~39 versus 51 (placebo).5
    • Cognition, bone density, muscle strength, mood: No difference.1
    • Adverse events:1,2
      • Severe: No difference.
      • Acne: 7.2% versus 5% (placebo), number needed to harm (NNH)=19.
      • Hirsutism: 12% versus 8% (placebo), NNH=25.
      • Weight: +0.5kg with testosterone at 6-12 months versus placebo.
    • Other systematic reviews:3,4
  • Recent RCT: 70 post-menopausal women on estradiol, low sexual function. Transdermal testosterone versus placebo.6 At 8 weeks:
    • Proportion with no sexual dysfunction: 56% versus 39% (placebo), number needed to treat=6.
  • Limitations: High drop-out rates (on placebo); uncertain randomization concealment; different measurement scales used.
CONTEXT
CONTEXTE
  • Guidelines:7,8
    • May consider off-label testosterone for hypoactive sexual desire disorder after addressing other causes.
    • Testosterone gel 1%: One-half pump daily to posterior calf.7
    • Levels not recommended for diagnosis. If treatment initiated, total testosterone levels at baseline, 3-6 weeks and every 6 months (target ≤2.8nmol/L).7
    • Onset: 1-3 months. Discontinue if no benefit at 6 months.

Walid Eshumani February 27, 2026

Thank you!

Robert Ramsey March 5, 2026

will follow the evidence

Jeremy Keller March 8, 2026

good to know there is some evidence for this practice, interesting to compare to men on testosterone in the future

Lyn Boorman March 15, 2026

I have a recent patient re this issue.Will start topical testosterone 1%,1/2 pump daily x 2-3 months.in menopausal women with PCOS,would the topical gel increase risk of hirusitism

Lyn Boorman March 15, 2026

recent patient with this concern, will discuss testosterone replacement

Lyn Boorman March 15, 2026

I do not understand what you require as a comment

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Author(s)
Auteur(s)
  • Jennifer Young CCFP
  • Sarah Le Roux CCFP
  • Samantha Moe Pharm. D. ACPR.

1. Islam RM, Bell RJ, Green S et al. Lancet Diabetes Endocrinol. 2019 Oct; 7(10):754-766.

2. Achilli C, Pundir J, Ramanathan P et al. Fertil Steril. 2017 Feb; 107(2): 475-482.e15.

3. Somboonporn W, Davis S, Seif MW et al. Cochrane Database Syst Rev. 2005 Oct 19; (4): CD004509.

4. Elraiyah T, Sonbol MB, Wang Z et al. J Clin Endocrinol Metab. 2014 Oct; 99(10): 3543-50.

5. Davis SR, Moreau M, Kroll R et al. N Engl J Med. 2008 Nov 6; 359(19): 2005-17.

6. Chaikittisilpa S, Soimongkol K, Jaisamrarn U. Climacteric 2019; 22: 5: 460-5.

7. Wolffman W, Krakowsky Y, Fortier M. J Obstet Gynaecol Can 2021; 43(11):1334−1341.

8. Parish SJ, Simon JA, Davis SR et al. J Sex Med. 2021 May; 18(5):849-867.

Authors do not have any conflicts of interest to declare.