Non-oral testosterone effective for low sexual function in postmenopausal women

By Nicole MacKee
Non-oral testosterone therapy has been given the go-ahead as a safe and effective treatment for postmenopausal women experiencing distress because of low sexual desire.

A systematic review and meta-analysis, published in The Lancet Diabetes and Endocrinology, found that, compared with placebo or comparator therapy (such as oestrogen with or without progestogen), testosterone therapy significantly increased sexual function, including sexual desire (standardised mean difference, 0.36) and pleasure (mean difference, 6.86). Testosterone therapy also reduced sexual concerns (mean difference, 8.99) and distress (standardised mean difference, -0.27).

The findings informed the release this month of a global position statement on the role of testosterone therapy in postmenopausal women’s sexual function, which was simultaneously published in four international journals (Climacteric, Maturitas, The Journal of Sexual Medicine and the Journal of Endocrinology and Metabolism).

Coauthor of The Lancet Diabetes and Endocrinology review, Professor Susan Davis, Professor of Women’s Health at Monash University, Melbourne, welcomed the global consensus.

‘No one has ever published a guideline and [this position statement] gives very clear recommendations on measuring testosterone, who should be treated, aims of treatment and how you should treat,’ Professor Davis said, noting that consensus was achieved among 12 international authorities, including the International Menopause Society, UK’s Royal College of Obstetrics and Gynaecology, US Endocrine Society and the International Society of Sexual Medicine.

Professor Davis said testosterone had long been used in Australia to treat postmenopausal women with concerns about low sexual desire, but there had been much debate about the treatment’s benefits and risks.

‘For postmenopausal women with low sexual desire associated with distress or real concern, an overall consistent benefit was seen across all the studies [in the systematic review and meta-analysis],’ Professor Davis said, adding that a key strength of the research was its inclusion of unpublished data used in drug development, as well as published data.

The review also confirmed current practice of favouring transdermal delivery, because of the adverse lipoprotein effects oral testosterone. Although some mild androgenic side effects, such as acne and increased hair growth, were reported, the researchers said these effects were not sufficiently concerning to prompt women to withdraw from trials.

Professor Davis added that no benefit was found for individual wellbeing, musculoskeletal health, cognitive health or depression, and the jury remained out on the safety and effectiveness of testosterone therapy in premenopausal women on account of a paucity of data in this cohort.

The researchers analysed 46 randomised controlled trials (RCT) of at least 12 weeks’ duration with 8480 participants. Testosterone treatments that achieved blood levels equivalent to those achieved with a 300 mcg transdermal patch, the upper end of the premenopausal range, were included. The researchers said further research was needed to clarify the effects of testosterone therapy in premenopausal women and on long-term safety.
Lancet Diabetes Endocrinol 2019; S2213-8587(19)30189-5.