A Systematic Review of Randomized Controlled Trials Investigating the Efficacy and Safety of Testosterone Therapy for Female Sexual Dysfunction in Postmenopausal Women

Channa N. Jayasena; Fatima M. Alkaabi; Curtis S. Liebers; Thomas Handley; Stephen Franks; Waljit S. Dhillo


Clin Endocrinol. 2019;90(3):391-414. 

In This Article


Sexual dysfunction is a common problem in postmenopausal women, which may profoundly affect quality of life. Endogenous testosterone may influence sexual behaviour in women. However, there is a lack of evidence implicating deficient endogenous testosterone in the evolution of sexual dysfunction in women. Furthermore, there is considerable variation in the prevalence of menopause-related sexual dysfunction, depending on the criteria employed. Several randomized, placebo-controlled clinical trials suggest that testosterone therapy significantly improves sexual function assessed using validated questionnaires, in postmenopausal women with sexual dysfunction or hypoactive sexual desire disorder. The effect size is modest, with approximately one additional satisfactory sexual activity per month. In the short-term, testosterone therapy is generally well tolerated and safe adverse effects predominantly consist of localized skin reactions and cosmetic effects of hyperandrogenaemia. Possible impacts on lipid metabolism, cardiovascular and cancer risk warrant further detailed investigations, although no major safety concerns have been raised to date. In line with the US Endocrine Society Clinical Practice Guidelines, there is currently insufficient evidence regarding general recommendations for testosterone therapy in women.[28] There are also no licensed products in the UK for female administration of testosterone; testosterone preparations designed to administer much higher doses (to men) must therefore be used. If clinicians are considering offering this treatment to postmenopausal women, it is necessary to provide full counselling on the risks and benefits, particularly the limited effect of testosterone and the lack of long-term safety data. However with these caveats, there is sufficient evidence to recommend testosterone therapy for the minority of postmenopausal women for whom other management strategies have failed.