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.
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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Simon, J. A. et al. The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): International Society for the Study of Women’s Sexual Health (ISSWSH) expert consensus panel review. Menopause 25, 837–847 (2018).
Clayton, A. H. et al. The International Society for the Study of Women’s Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women. Mayo Clin. Proc. 93, 467–487 (2018).
Pfaus J. G. & Jones S. L. in Textbook of Female Sexual Function and Dysfunction: Diagnosis and Treatment (eds Goldstein, I. et al.) 25–52 (John Wiley & Sons, 2018).
Davis, S. R. & Wahlin-Jacobsen, S. Testosterone in women—the clinical significance. Lancet Diabetes Endocrinol. 3, 980–992 (2015).
Islam, R. M. et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 7, 754–766 (2019).
Davis, S. R. et al. Global consensus position statement on the use of testosterone therapy for women. J. Clin. Endocrinol. Metab. 104, 4660–4666 (2019).
Zimmerman, Y. et al. The effect of combined oral. contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum. Reprod. Update 20, 76–105 (2014).
Both, S. et al. Hormonal contraception and female sexuality: position statements from the European Society of Sexual Medicine (ESSM). J. Sex. Med. 16, 1681–1695 (2019).
Zethraeus, N. et al. Combined oral contraceptives and sexual function in women-a double-blind, randomized, placebo-controlled trial. J. Clin Endocrinol. Metab. 101, 4046–4053 (2016).
Battaglia, C. et al. Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study. J. Sex. Med. 11, 471–80 (2014).
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
Sexual Medicine (2020)