Testosterone therapy aids sexual desire in women

Women in menopause, particularly when it is surgically induced, often suffer decreased sexual desire and activity, even if they are on estrogen replacement therapy.

According to a new position statement released by the North American Menopause Society (NAMS), testosterone therapy has been shown to improve sexual function in postmenopausal women. Featured in the September/October issue of Menopause, the society's official journal, the statement includes clinical evidence supporting the use of testosterone in these postmenopausal women-along with a list of available testosterone formulations, adverse events associated with the products, and monitoring recommendations.

"Postmenopausal women should first be evaluated for other causes of their sexual concerns,"said Jan L. Shifren, M.D., assistant professor of obstetrics, gynecology, and reproductive biology, Harvard Medical School, and director, menopause program, Vincent Obstetrics and Gynecology Service, Massachusetts General Hospital, Boston. Depression or anxiety, as well as use of antidepressants or alcohol, can also decrease sexual desire.

Prior to initiating testosterone therapy, the statement authors advise, clinicians should tell women that none of the available testosterone products is Food " Drug Administration-approved for the treatment of sexual function disorders. Testosterone therapy is, however, available in a variety of strengths and formulations. An oral testosterone derivative, methyltestosterone, has joined up with estrogen in the form of Estratest (Solvay Pharmaceuticals), FDA-approved for the treatment of moderate to severe vasomotor symptoms unresponsive to estrogens. Experts caution that since oral testosterone formulations undergo first-pass hepatic metabolism, adverse effects on liver function and lipids are possible.

Testosterone can be administered transdermally with gels, creams, or patches, or injected intramuscularly. Transdermal means are preferred to oral products because of the first-pass hepatic effects seen with oral formulations, said the authors.

Androderm (Watson) and Testoderm (ALZA) transdermal patches are indicated for men. While these agents can cause masculinizing effects in women, patches delivering lower doses of testosterone are being investigated. Results of a study published in the New England Journal of Medicine in 2005 demonstrated that a testosterone 300 µg/day patch improved sexual function in women with surgically induced menopause.

AndroGel (Solvay Pharmaceuticals) and Testim (Auxilium) testosterone gels are also approved for use in men and can cause masculinizing adverse effects in women.

Custom-compounded testosterone gels, creams, and ointments are often used for improving women's sexual desire. An appropriate dose of compounded 1% testosterone gel, cream, or ointment is 0.5g/day and should deliver 5 mg testosterone daily-one-tenth the generally prescribed dose for men. "Dosing may be inconsistent with these products, and we have limited information on the risks and benefits of these formulations," Shifren said. All intramuscular testosterone products approved in the United States are indicated only for use in men.

According to the paper, women should be monitored during testosterone therapy for adverse events, including acne, excess hair growth, and edema. The authors also suggest performing baseline liver function tests and a lipid profile prior to initiating treatment-particularly with oral testosterone. Testosterone should not be initiated in postmenopausal women with breast or uterine cancer or cardiovascular or liver disease.

THE AUTHOR is a writer and hospital pharmacist based in New Jersey.