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#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.

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Author(s)
Auteur(s)
  • Jennifer Young CCFP
  • Samantha Moe PharmD
  • Sarah Le Roux MD

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.