Androgens and Female Sexual Dysfunction

Sexual problems experienced by women include: i) Low interest or motivation to engage in sexual activity (libido), ii) Diminished capacity for vaginal lubrication and arousal, iii) Difficulty achieving /or absent orgasm, and/or iv) Dyspareunia Usually in the context of a sexual relationship these problems are associated with a decrease in the frequency and pleasure of sexual activity and can become a source of tension and distress for the individual and her partner. Androgens have widespread actions in women through the androgen receptor and as an obligatory precursors for ovarian and extra-gonadal oestrogen production. Circulating levels of testosterone decline significantly with age from the mid reproductive years. This has stimulated interest in the physiological consequences of this decline and in defining a clinical syndrome of female androgen insufficiency. However, the complex extra-gonadal tissue metabolism of testosterone has limited the interpretation of the relationships between circulating blood levels of testosterone and specific clinical endpoints, as blood may not necessarily reflect tissue levels. There is now substantial evidence from randomized controlled trials that premenopausal and postmenopausal non oral testosterone therapy improves sexual desire, arousal, responsiveness and sexual satisfaction in postmenopausal women either on concurrent estrogen or not receiving estrogen therapy. The efficacy of transdermal testosterone appears to be greatest in women either not using estrogen or using non oral estrogen therapy. Concurrent use of conjugated equine estrogen appears to impair any therapeutic benefit of testosterone. The safety data for testosterone use in women are limited to studies of less than or equal to 12 months duration. Therefore although there is no evidence that the use of testosterone is unsafe, that long term safety data for testosterone in women are lacking ongoing use should be carefully considered and closely monitored .

Conflict of Interest: Consultant For Procter & Gamble, Acrux And Organon
Financial Support/Funding: NHMRC, Procter & Gamble, Acrux And Organon
Sydney Australia, April 2007