Non-oral testosterone is effective for increasing low sex drive that causes concern in naturally and surgically postmenopausal women, according to study results published in The Lancet.

Investigators conducted a systematic review and meta-analysis of randomized controlled trials and drug registration applications to evaluate the risks and benefits associated with testosterone therapy in women with low libido. Primary outcomes included the effects of testosterone on sexual function, cardiometabolic outcomes, cognitive measures, and musculoskeletal health.

Data collected from 8480 participants suggested that compared with placebo or a comparator, testosterone significantly increased the following sexual functions in postmenopausal women: satisfactory sexual event frequency (average difference, 0.85), sexual desire (standardized average difference, 0.36), pleasure (average difference, 6.86), arousal (standardized average difference, 0.28), orgasm (standardized average difference, 0.25), responsiveness (standardized average difference, 0.28), and self-image (average difference, 5.64). Results revealed a reduction in sexual concerns (average difference, 8.99) and distress (standardized average difference, −0.27).

The oral administration of testosterone resulted in a significant rise in low-density lipoprotein cholesterol levels and a fall in total cholesterol, high-density lipoprotein cholesterol, and triglycerides, which was not observed in women taking non-oral testosterone.

Treatment was associated with weight gain and a significantly greater chance of reporting acne and hair growth. Effects on body composition, musculoskeletal outcomes, or cognitive measures were not reported.

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The investigators noted that this study “provides robust support for a trial of testosterone treatment, using a dose appropriate for women, when clinically indicated in postmenopausal women. The absence of any approved testosterone formulations for women in any country, however, is a major treatment barrier.”

“Further research is needed to clarify the effects of testosterone treatment in premenopausal women and the effects on musculoskeletal and cognitive health and long-term safety,” concluded the investigators.   

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Reference Islam RM, Bell RJ, Green S, Page MJ, Davis SR. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet. doi:10.1016/s2213-8587(19)30189-5