Recent research indicates testosterone therapy improves sexual wellbeing in postmenopausal women. However, without any long-term safety data or guidelines, should GPs be offering treatment to patients?
Across all the studies that have been done, about 60% of women have a good response to treatment, with around a four-to-six-week lag from initiating treatment to getting a response. The short-term safety data for two years, including for breast health, is excellent with no evidence of serious adverse events. There was a slight increase in women reporting acne and hair growth. Long-term safety data is still required, particularly for breast cancer and I would use other modalities to address low testosterone in women with a personal history of this.
Low libido causes distress in one in three middle-aged women and 15% of women aged 60 to 80 years. This is vastly under reported in my opinion.
They are the patients leading societies in the US and UK had in mind in their recent global consensus statement, which said the evidence supports the use of testosterone therapy for women with hypoactive sexual desire disorder (HSDD).
I warn patients they are not going to be jumping from the rafters the day after they apply the cream and that the response can take 3 months and be subtle. Women become more responsive and positive, and they may get sexual thoughts, but it may not be dramatic.
There is no magic test to diagnose a woman with low libido, it is based on history. In functional medicine, we always do a thorough history, examination and comprehensive blood tests including those to rule out iron deficiency, thyroid and kidney disease and baseline hormone levels.
Testosterone therapy initially needs close monitoring with a follow up in 3 months for blood tests to ensure that it is a physiological dose and there has been a positive response. Once there has been a stable established period of benefit, a 6 monthly review would be routine.
