Androgen Replacement Therapy in Women

Marie Lebbe; David Hughes; Nicole Reisch; Wiebke Arlt


Expert Rev Endocrinol Metab. 2012;7(5):515-529. 

In This Article

Female Androgen Deficiency Syndrome & Hypoactive Sexual Desire Syndrome

The Princeton consensus statement published in 2002 by an expert panel from the USA and Australia defined female androgen deficiency syndrome (FADS) as the presence of symptoms of decreased well-being and libido, occurring in a woman with androgen levels in the lower quartile of the normal female range and adequate levels of estrogens.[28] The lack of specificity of the aforementioned clinical symptoms and the heterogeneity in current testosterone assays represent major barriers to widespread acceptance of the definition of FADS.[29] There is some agreement now that this definition is too imprecise and would result in labeling a significant percentage of the female population as suffering from the so-called FADS. Different terms have been used for the psychiatric assessment of female sexual dysfunction. Hypoactive sexual desire syndrome (HSDD) is currently defined in the DSM classification as 'personal distress resulting from a diminished feeling of sexual interest, sexual thoughts and lack of responsive desire beyond what would be considered normal for time of life and duration of the relationship'. According to the consensus of the Sexual Function Health Council of the American Foundation for Urologic Disease, HSDD is defined by persistent or recurrent deficiency of sexual fantasies, thoughts and/or desire for, or receptivity to, sexual activity resulting in personal distress.[30] Recent figures indicated a 50% incidence of female sexual dysfunction based on these criteria in a gynecology outpatient cohort.[31] Analysis of data from the National Health and Social Life Survey on 1749 women aged 18–59 years showed the prevalence of sexual dysfunction to be 43% in the USA.[32] HSDD is obviously of multifactorial origin, and although androgen deficiency may contribute, this entity should not be confused with the endocrine syndrome of female androgen insufficiency. Importantly, a recently published cross-sectional study in a cohort of 1423 Australian women found no significant correlation of circulating androgen levels with self-reported perception of sexual desire and sexual satisfaction.[33]

The guidelines published by the Endocrine Society in 2006 recommended against making a diagnosis of androgen deficiency in women because of the lack of a clearly defined clinical syndrome and of normative data on testosterone levels across women's lifespan that can be used to define the disorder.[34] Given recent publications and developments, it may be time to revisit this guidance, considering the development of mass spectrometry-based highly sensitive testosterone assays, the availability of satisfactory forms of testosterone administration and emerging data on short-term safety of testosterone replacement in women.