The current outlook for testosterone in the management of hypoactive sexual desire disorder in postmenopausal women.

INTRODUCTION: Hypoactive sexual desire disorder (HSDD) is a common clinical problem in women, especially those who have experienced surgical menopause. Because androgen levels decline with age and drop dramatically following bilateral oophorectomy, it has been hypothesized that reduced levels of testosterone are related to diminished desire.

AIM: As presented at a continuing medical education satellite symposium during the 2008 annual meeting of the International Society for the Study of Women's Sexual Health, to review the current state of knowledge about the physiologic effects of testosterone in postmenopausal women, the effects of transdermal testosterone delivery in surgically menopausal women with HSDD, and ongoing studies of a transdermal testosterone gel.

METHODS: A review of the pertinent literature, including recent presentations.

MAIN OUTCOME MEASURES: Results from the Women's International Study of Health and Sexuality; and studies utilizing the Brief Index of Sexual Functioning for Women, the Psychological General Well-Being Index, and validated instruments that assess female sexual function: the Sexual Activity Log, the Profile of Female Sexual Function, and the Personal Distress Scale.

RESULTS: Surgically menopausal women receiving testosterone experience significant increases in total satisfying sexual activity vs. women receiving placebo, significant improvement in all domains of sexual function, and decreases in personal distress, with a favorable safety profile.

CONCLUSIONS: Testosterone deficiency may be considered among the underlying causes of HSDD. Currently, testosterone is available to women in the United States only via off-label prescribing or by unregulated compounding of testosterone preparations. New safety trials will examine the long-term safety of testosterone gel in surgically menopausal women with HSDD who are at high risk of cardiovascular disease or breast cancer.