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SEXUAL MEDICINE IN 2019

Testosterone in women: are we closing the gender gap?

Nature Reviews Urology volume 17, pages 67–68 (2020)Cite this article

Subjects

The role of testosterone in female sexuality is still controversial. In 2019, a meta-analysis and a Position Statement on testosterone therapy for hypoactive sexual desire disorder in menopausal women and a Position Statement on the potential sexual adverse effects of hormonal contraception have begun to close this gender gap.

Key advances

  • The only evidence-based indication for testosterone therapy in women is hypoactive sexual desire disorder (HSDD), diagnosed in postmenopausal women after a complete biopsychosocial assessment and not by low serum testosterone levels2,6.

  • Meta-analytic data show that testosterone treatment in postmenopausal women with HSDD is associated with a significant increase in the number of satisfying sexual events and in sexual desire5.

  • Non-oral testosterone treatment in postmenopausal women was not associated with adverse events, including effects on lipid profile, in a meta-analysis5.

  • All available combined hormonal contraceptives similarly increase sex hormone-binding globulin and decrease androgen levels, independent of route of administration, oestrogen dose and progestin type (androgenic versus anti-androgenic)8.

  • Low-quality data suggest that in cases of HSDD related to the use of hormonal contraceptives, patients can be switched to non-hormonal contraception, or from oral to non-oral contraception, or from oral hormonal to other, non-oestrogen-containing, forms of oral contraception8.

  • Low-quality data suggest that women with hormonal-contraceptive-related decreased lubrication can be switched to non-hormonal contraception, or from oral to non-oral contraception, or to other forms of oral contraception containing higher ethinyloestradiol doses8.

Gender inequality still affects countless areas of science and global health, including sexual medicine. Different susceptibilities and exposures to risk factors, discriminatory norms and practices and, most importantly, biases in health-care systems and research contribute to a gender-related barrier to proper medical counselling, support and care for women’s sexual needs and concerns throughout their life span. Our knowledge of the pathophysiological processes involved in women’s sexual response has lagged far behind our understanding of these processes in men, leading to a shortage of products approved by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to treat sexual symptoms in women, compared with a large number of therapies available for men. At the same time, high-quality evidence regarding the effects of hormonal contraception on circulating sex steroids and, therefore, female sexual function is extremely scarce, despite its widespread use in the USA and Europe and the fact that both women and health-care providers attribute more and more importance to sexual wellbeing.

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References

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Author information

Authors and Affiliations

  1. Andrology, Women’s Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy

    Linda Vignozzi

  2. Flare-Health, W.H. Keesomlaan 12, Amstelveen, Netherlands

    Yacov Reisman

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  1. Linda Vignozzi
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  2. Yacov Reisman
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Correspondence to Linda Vignozzi.

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The authors declare no competing interests.

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Vignozzi, L., Reisman, Y. Testosterone in women: are we closing the gender gap?. Nat Rev Urol 17, 67–68 (2020). https://doi.org/10.1038/s41585-019-0266-3

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