Sexuality in the Aging Couple, Part I: The Aging Woman

Irwin W. Kuzmarov, MD, FRCSC; Jerald Bain, BScPhm, MD, MSc, FRCPC, CertEndo, BA

Disclosures

Geriatrics and Aging. 2008;11(10):589-594. 

In This Article

Testosterone Therapy in Women

Sherwin and Gelfand published one of the early studies assessing the effect of testosterone therapy on the sexual functioning of oophorectomized women.[26] They divided their study subjects into three groups: no treatment, estrogen-only treatment, and treatment with a combination of estrogen and androgen. In several sexual domains, including sexual arousal, the estrogen/androgren combination was significantly more effective in producing positive and sexually satisfying results.

When androgen levels in healthy adult females are studied over decades there is a significant decline with a flattening in the mid-years and no further decline in the transition through and beyond menopause. Menopausal ovaries continue to produce testosterone but both total and free testosterone drop precipitously with oophorectomy in menopausal women. Total goes from a mean of 0.66 nmol/L to 0.38, and free goes from 10.81 pmol/L to 5.54.[27]

In 1999, Davis predicted that the use of testosterone therapy in women would become more widespread because of the emerging evidence of testosterone's beneficial effects on libido, fatigue, and general sense of well-being.[28] Her prediction has come to fruition. Multiple studies have appeared in the literature and in 2006 the Endocrine Society published a clinical guideline on androgen therapy in women. The guidelines recommended "against the generalized use of testosterone by women because the indications are inadequate and evidence of safety in long-term studies is lacking."[29] The guideline supported further research particularly in areas where there are abrupt and marked changes in androgens such as surgical menopause, hypopituitarism, anorexia nervosa, or adrenal insufficiency. The guideline also re-emphasized the difficulty in measuring testosterone levels in women and argued against making a diagnosis of androgen deficiency in women.

A multicentre, double-blind, placebo-controlled study in which 814 women with hypoactive sexual desire disorder were randomly assigned to either one of two doses of a testosterone patch or placebo was recently published.[10] The authors of this study did find modest but statistically significant improvements in satisfying sexual episodes in the group being treated with the higher dose of testosterone (300 µg per day). These findings indicated that the added use of estrogen or an estrogen-progestogen combination were not essential for testosterone to induce its positive effects on sexual arousal. There were, however, four women in the treatment group and none in the placebo group who developed breast cancer. The authors suggested that this could be due to chance but a cause and effect relationship could not be excluded.

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