Testosterone may be beneficial in postmenopausal women

Testosterone treatment could significantly improve sexual wellbeing for postmenopausal women, according to a review published in The Lancet Diabetes & Endocrinology, with benefits including improved sexual desire, function and pleasure, together with reduced concerns and distress about sex.

Although best known as a male hormone, testosterone is important for female sexual health, contributing to libido and orgasm as well as helping to maintain normal metabolic function, muscle strength, cognitive function and mood. Levels decline naturally over a woman’s lifespan, particularly during menopause (including surgical menopause) — but while prior research has suggested that testosterone therapy can improve sexual function in women, the available formulations have been designed for men and evidence for their safety or for adverse side effects in women is scant.

Now, scientists have reviewed 46 reports about 36 randomised controlled trials, conducted between January 1990 and December 2018 and involving 8480 participants aged 18 to 75 years, approximately 95% of whom were postmenopausal. The trials compared testosterone treatment to a placebo or to an alternative hormone treatment such as oestrogen, with or without progestogen.

In 15 studies involving 3766 naturally and surgically postmenopausal women, consistent beneficial effects were seen for all measures of sexual function. Testosterone treatment resulted in an increase in the frequency of satisfactory sexual events, while also increasing sexual desire, pleasure, arousal, orgasm, responsiveness to sexual stimuli and self-image. Women treated with testosterone also showed reduced measures of sexual concerns and sexually associated distress.

“The beneficial effects for postmenopausal women shown in our study extend beyond simply increasing the number of times a month they have sex,” said senior author Professor Susan Davis, from Monash University. “Some women who have regular sexual encounters report dissatisfaction with their sexual function, so increasing their frequency of a positive sexual experience from never, or occasionally, to once or twice a month can improve self-image and reduce sexual concerns, and may improve overall wellbeing.”

The review found no beneficial effects on cognitive measures, bone mineral density, body composition or muscle strength. No benefits were seen for depressive mood irrespective of menopausal status or in psychological wellbeing; however, further research is needed as the number of women included in the studies was small.

Postmenopausal women treated with testosterone were no more likely to experience a serious cardiovascular event such as a heart attack or stroke (nine clinical trials with 4063 women). No serious adverse effects were recorded for glucose or insulin in the blood, for blood pressure or for measures of breast health; however, only limited data were available for breast cancer risk.

Although an increase in acne was shown in 11 studies involving 3264 women, and an increase in hair growth was shown in 11 studies involving 4178 women, the number of participants who withdrew from clinical trials due to these side effects was not greater for women treated with testosterone compared with placebo, suggesting the effects are mild and not a major concern for participants. Five studies involving 2032 participants indicated that testosterone treatment was associated with some weight gain.

With non-oral testosterone, the authors found no effects on lipid profiles or metabolic variables such as cholesterol (10 studies involving 1774 women). Oral formulations of testosterone increased LDL cholesterol and reduced HDL cholesterol, overall cholesterol and triglycerides (a type of fat associated with an increased risk of heart disease).

The authors concluded that non-oral formulations are preferred because of the adverse lipoprotein effects of oral testosterone. So far, adverse side effects of non-oral formulations appear to be restricted to small weight gain, mild acne and increased hair growth, but more research on long-term effects is needed. The authors thus recommend that patients are advised of these effects so they can make an individual choice whether to go ahead with testosterone treatment.

“Our results suggest it is time to develop testosterone treatment tailored to postmenopausal women rather than treating them with higher concentrations formulated for men,” Prof Davis said. “Nearly a third of women experience low sexual desire at midlife, with associated distress, but no approved testosterone formulation or product exists for them in any country and there are no internationally agreed guidelines for testosterone use by women. Considering the benefits we found for women’s sex lives and personal wellbeing, new guidelines and new formulations are urgently needed.”

Image credit: ©stock.adobe.com/au/hebstreit

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