Testosterone therapy for hypoactive sexual desire disorder in women
DOI:
https://doi.org/10.12775/QS.2025.41.58680Keywords
systemic testosterone, hypoactive sexual desire disorder, female sexual dysfunction, ISSWSH, testosterone therapy, menopause, sexual arousalAbstract
Introduction and Purpose: Testosterone plays a pivotal role in women’s sexual health, influencing sexual desire, arousal, and satisfaction. This hormone, primarily produced in the ovaries, adrenal glands, and adipose tissue, declines with age, especially during menopause, leading to sexual dysfunction such as hypoactive sexual desire disorder (HSDD). The purpose of this article is to review the role of testosterone in female sexual function, evaluate the efficacy and safety of testosterone therapy (TRT) for women with HSDD, and discuss the ongoing challenges in its use.
Materials and Methods:The article is a comprehensive review of current literature, including clinical studies and trials involving testosterone therapy in women with low libido, especially in postmenopausal women. It highlights the various forms of testosterone supplementation, such as transdermal patches and topical gels, as well as monitoring recommendations for assessing testosterone levels and side effects during treatment.
Results: Testosterone therapy has shown promising results in improving sexual desire, arousal, and satisfaction in women, particularly those postmenopausal or following surgical castration. While the therapy is generally well-tolerated, common side effects include acne, hirsutism, and voice deepening. The optimal dosing regimen and long-term safety, especially in premenopausal women, remain unclear, with ongoing studies indicating positive short-term outcomes. Clinical guidelines recommend individualized treatment.
Conclusion:Testosterone replacement therapy is a viable option for women with HSDD, particularly in those with diminished testosterone levels due to menopause or surgical intervention. While promising, careful management is essential to mitigate side effects and ensure patient safety. Continued research is necessary to establish standardized treatment protocols and to further assess the long-term effects of testosterone therapy on women’s sexual health.
References
1. Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. J Womens Health (Larchmt). 2021;30(4):474-491. doi:10.1089/jwh.2021.29037
2. Cappelletti M, Wallen K. Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens. Horm Behav. 2016;78:178-193. doi:10.1016/j.yhbeh.2015.11.003
3. Ingram CF, Payne KS, Messore M, Scovell JM. Testosterone therapy and other treatment modalities for female sexual dysfunction. Curr Opin Urol. 2020;30(3):309-316. doi:10.1097/MOU.0000000000000759
4. Alemany M. The Roles of Androgens in Humans: Biology, Metabolic Regulation and Health. Int J Mol Sci. 2022;23(19):11952. Published 2022 Oct 8. doi:10.3390/ijms231911952
5. Ainslie RJ, Simitsidellis I, Kirkwood PM, Gibson DA. RISING STARS: Androgens and immune cell function. J Endocrinol. 2024;261(3):e230398. Published 2024 Apr 29. doi:10.1530/JOE-23-0398
6. Moreau KL, Babcock MC, Hildreth KL. Sex differences in vascular aging in response to testosterone. Biol Sex Differ. 2020;11(1):18. Published 2020 Apr 15. doi:10.1186/s13293-020-00294-8
7. Parish SJ, Hahn SR. Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment. Sex Med Rev. 2016;4(2):103-120. doi:10.1016/j.sxmr.2015.11.009
8. Maharjan DT, Syed AAS, Lin GN, Ying W. Testosterone in Female Depression: A Meta-Analysis and Mendelian Randomization Study. Biomolecules. 2021;11(3):409. Published 2021 Mar 10. doi:10.3390/biom11030409
9. O'Loughlin JI, Basson R, Brotto LA. Women With Hypoactive Sexual Desire Disorder Versus Sexual Interest/Arousal Disorder: An Empirical Test of Raising the Bar. J Sex Res. 2018;55(6):734-746. doi:10.1080/00224499.2017.1386764
10. Marino L, Messina A, S Acierno J, et al. Testosterone-induced increase in libido in a patient with a loss-of-function mutation in the AR gene. Endocrinol Diabetes Metab Case Rep. Published online June 1, 2021. doi:10.1530/EDM-21-0031
11. Johansen N, Lindén Hirschberg A, Moen MH. The role of testosterone in menopausal hormone treatment. What is the evidence?. Acta Obstet Gynecol Scand. 2020;99(8):966-969. doi:10.1111/aogs.13819
12. Sarrel PM, Sullivan SD, Nelson LM. Hormone replacement therapy in young women with surgical primary ovarian insufficiency. Fertil Steril. 2016;106(7):1580-1587. doi:10.1016/j.fertnstert.2016.09.018
13. Bolour S, Braunstein G. Testosterone therapy in women: a review. Int J Impot Res. 2005;17(5):399-408. doi:10.1038/sj.ijir.3901334
14. Shuster LT, Rhodes DJ, Gostout BS, Grossardt BR, Rocca WA. Premature menopause or early menopause: long-term health consequences. Maturitas. 2010;65(2):161-166. doi:10.1016/j.maturitas.2009.08.003
15. 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 Diabetes Endocrinol. 2019;7(10):754-766. doi:10.1016/S2213-8587(19)30189-5
16. Huo YN, Yeh SD, Lee WS. Androgen receptor activation reduces the endothelial cell proliferation through activating the cSrc/AKT/p38/ERK/NFκB-mediated pathway. J Steroid Biochem Mol Biol. 2019;194:105459. doi:10.1016/j.jsbmb.2019.105459
17. Vegunta S, Kling JM, Kapoor E. Androgen Therapy in Women [published correction appears in J Womens Health (Larchmt). 2020 Nov;29(11):1487. doi: 10.1089/jwh.2018.7494.correx.]. J Womens Health (Larchmt). 2020;29(1):57-64. doi:10.1089/jwh.2018.7494
18. Weiss RV, Hohl A, Athayde A, et al. Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism. Arch Endocrinol Metab. 2019;63(3):190-198. Published 2019 Jul 18. doi:10.20945/2359-3997000000152
19. Jang C, Boyle JA, Vincent A. Global consensus statement on testosterone therapy for women: an Australian perspective. Med J Aust. 2020;213(10):449-452.e1. doi:10.5694/mja2.50837
20. Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Sex Med. 2019;16(9):1331-1337. doi:10.1016/j.jsxm.2019.07.012
21. Reed BG, Bou Nemer L, Carr BR. Has testosterone passed the test in premenopausal women with low libido? A systematic review. Int J Womens Health. 2016;8:599-607. Published 2016 Oct 13. doi:10.2147/IJWH.S116212
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Jagoda Misiuk Misiuk, Karolina Kopeć, Aleksandra Bartoszek, Julia Adamiuk, Agnieszka Marut, Marta Biskup, Adriana Skuba, Katarzyna Załuska, Sylwia Nykiel, Agnieszka Świdniak

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 81
Number of citations: 0