Testosterone in women: are we closing the gender gap?

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.

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Correspondence to Linda Vignozzi.

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Vignozzi, L., Reisman, Y. Testosterone in women: are we closing the gender gap?. Nat Rev Urol 17, 67–68 (2020).

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