Correspondence

Testosterone for Low Libido

N Engl J Med 2009; 360:728-729February 12, 2009

Article

To the Editor:

Neither serum levels of testosterone nor total androgen activity as assessed by measurement of androgen metabolites has been shown to correlate with women's sexual function.1,2 Given the reduction in testosterone production with age — most notably, the intracrine production from adrenal precursors3 — it is reasonable to hypothesize that some middle-aged and older women might have sexual dysfunction due to insufficient testosterone. The difficulty with the trial reported by Davis et al. (Nov. 6 issue)4 and previous trials is that at baseline, the recruited women reported that approximately 50% of their sexual experiences were satisfying, with an average of two to three satisfying experiences per month. There remains debate about whether this constitutes sexual disorder.1 Moreover, nonmedical factors are surely at play in these nonrewarding experiences: biologic factors (e.g., a testosterone deficit) would cause consistent dysfunction. There is a need for studies that recruit women who have no satisfying sexual experiences: their former means of stimulating mind and body is no longer effective.1,5 Such women with sexual disorder according to recommended criteria have yet to be enrolled in randomized trials of testosterone supplementation.

Rosemary Basson, M.D.
University of British Columbia, Vancouver, BC V5Z 1M9, Canada
bassonrees@telus.net

5 References

1. 1

   Basson R. Sexual desire and arousal disorders in women. N Engl J Med 2006;354:1497-1506
   Full Text | Web of Science | Medline

2. 2

   Adler J, Zanetti R, Wight E, Urech C, Fink N, Bitzer J. Sexual dysfunction after premenopausal stage I and II breast cancer: do androgens play a role? J Sex Med 2008;5:1898-1906
   CrossRef | Web of Science | Medline

3. 3

   Labrie F, Belanger A, Belanger P, et al. Androgen glucuronides, instead of testosterone, as the new markers of androgenic activity in women. J Steroid Biochem Mol Biol 2006;99:182-188
   CrossRef | Web of Science | Medline

4. 4

   Davis SR, Moreau M, Kroll R, et al. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med 2008;359:2005-2017
   Full Text | Web of Science | Medline

5. 5

   Basson R, Leiblum S, Brotto L, et al. Revised definitions of women's sexual dysfunction. J Sex Med 2004;1:40-48
   CrossRef | Web of Science | Medline

Author/Editor Response

The aim of our study was to investigate the efficacy of transdermal testosterone therapy over a 6-month period and its safety over a 12-month period in women who met the criteria for hypoactive sexual desire disorder.1 Participants in the study had a range of frequencies of satisfying sexual events at baseline and included women who reported no satisfying events. Overall, the baseline data showed that the participants had a low frequency of satisfying sexual activities, that they seldom had sexual desire, and that they were all distressed by their loss of interest in sexual activity. Whether individual women experienced their former means of stimulating mind and body as no longer effective on all or only some occasions may not be a meaningful way of differentiating the severity of the condition from the individual woman's perspective. Rather, it may reflect sexual experience and knowledge and varying degrees of effort made by either the woman or her partner to enhance the sexual experience. The critical issue in describing this study population is that the participants felt that their loss of sexual desire was sufficiently severe that they wished to try a treatment to improve their sexual interest and sexual experience.

Susan R. Davis, M.D., Ph.D.
Monash University, Prahran, VIC 3181, Australia
susan.davis@med.monash.edu.au

Cindy Rodenberg, Ph.D.
Procter & Gamble Pharmaceuticals, Mason, OH 45040

1 References

1. 1

   Diagnostic and statistical manual of mental disorders, 4th ed.: DSM-IV. Washington, DC: American Psychiatric Association, 1994.
   

Citing Articles (1)

Citing Articles

1. 1

   Abdulmaged M. Traish, Louis J. Gooren. (2010) Safety of Physiological Testosterone Therapy in Women: Lessons from Female-to-Male Transsexuals (FMT) Treated with Pharmacological Testosterone Therapy. The Journal of Sexual Medicine 7:11, 3758-3764
   CrossRef