Testosterone for women
Female, sexual desire – interplay of the Head, Heart and Hormones
Testosterone is an important naturally occurring hormone in women and a precursor to oestrogen biosynthesis. Clinical trials have demonstrated that Intrinsa (a transdermal testosterone patch) improves sexual function and decreases distress in surgically menopausal women with Hypoactive Sexual Desire Disorder (HSDD) and is generally well tolerated with no safety concerns over 24 weeks. A follow-up open-label study has identified no significant safety concerns over three years. Leading clinical experts discussed the role of testosterone in women’s physiology and the clinical management of low sexual desire in surgically menopausal women at a symposium chaired by Professor John Studd from the London PMS and Menopause Centre. The meeting was held in Bournemouth during the British Menopause Society Annual Meeting in June 2007, and hosted by Procter & Gamble Pharmaceuticals UK Ltd
Reduced sexual desire is a common symptom in menopausal women. For the surgically menopausal patient (bilaterally oophorectomised and hysterectomised), the onset of sexual symptoms is often abrupt as the result of a dramatic decline in the levels of ovarian hormones. Specifically, testosterone serum levels decline dramatically following surgical menopause and low sexual desire may be a key consequence of testosterone loss.
Role of Intrinsa
In April 2007, Intrinsa, the first medically approved treatment for HSDD, was made available on prescription in the UK for surgically menopausal women receiving concomitant oestrogen therapy. ‘For more than three decades, I have been a strong exponent of testosterone for the management of sexual dysfunction for women with female androgen deficiency. Intrinsa is a welcome addition to our armamentarium of treatments for surgically menopausal women,’ remarked meeting Chairman, Professor John Studd. However, its introduction has also highlighted many issues on the identification and management of female sexual dysfunction.
Clinical considerations and the importance of communication
Female sexual response, or libido, is a complex interplay between biological and non-biological factors affected by ‘the head, heart and hormones’, observed Professor Studd. Open communication is the key to optimal management of female sexual health. Physiological factors including fatigue, depression, sexually negative effects of medications, reduced sex hormone activity, hyperprolactinaemia or hypothyroidism are important clinical considerations in determining the causes for female sexual dysfunction. In addition, clinicians need to take into account the many factors that affect sexual functioning, including everyday distractions of modern living, relationship difficulties, fear of a negative outcome (eg dyspareunia or partner dysfunction), past negative sexual experiences, or feelings of shame or embarrassment. Guided by a well-conducted frank discussion of sexual response and sexual activity, treatment in its various forms should be considered. The use of testosterone for HSDD within a good relationship is valuable but it is unlikely to sort out deep personality and relationship problems within a marriage. This history is an essential item of diagnosis and success. The measurement of pre-treatment testosterone levels is almost of no value for the diagnosis of HSDD.