What is HSDD?
Hypoactive sexual desire disorder (HSDD) is a condition characterized by a lack of sexual desire that causes distress or interpersonal difficulties. It is common in postmenopausal women.
How is HSDD diagnosed?
Before starting testosterone therapy, a thorough clinical assessment is necessary to rule out other factors contributing to sexual dysfunction. A blood total testosterone level should not be used to diagnose HSDD.
What type of transdermal testosterone therapy should I use?
There are no FDA-approved testosterone products specifically for women, so male formulations such as Androgel are often used at adjusted doses. For Androgel, typically 1/10th the dose of that used for men is prescribed for women. It is crucial to follow your doctor's instructions on how to apply the testosterone gel correctly. The use of compounded testosterone is not recommended due to concerns about dosing accuracy and safety.
How Effective is Testosterone Therapy?
Studies have shown that transdermal testosterone can significantly improve sexual desire, frequency of satisfying sexual episodes (typically 1-2 additional sexually satisfying encounters per month), and reduce personal distress related to low sexual desire. It takes 8 weeks to see benefit from this medication and 12-16 weeks for maximal benefit. Testosterone therapy should not be used for the prevention of any disease or for symptoms other than HSDD.
Is transdermal testosterone safe to use?
Short-term studies indicate that testosterone therapy is generally safe for postmenopausal women, with common side effects including increased hair growth and acne. However, the long-term safety of testosterone therapy, particularly its effects on cardiovascular health and breast cancer risk, remains uncertain. Long-term studies in transgender men using testosterone therapy are reassuring.
What are common side effects of testosterone therapy?
Common side effects include mild acne and increased hair growth. Long-term safety data are not yet available, so it is important to have regular follow-ups with your healthcare provider. Signs of excess testosterone include: acne, hair loss on the head with hair growth on the face, irreversible deepening of voice, and clitoral enlargement.
How do I monitor my blood testosterone levels and adjust my testosterone dose?
Regular monitoring of blood total testosterone levels is essential to ensure they remain within the physiological range for women. Here is the recommended bloodwork
protocol:
- Baseline Measurement: Before starting therapy, a baseline blood testosterone level will be measured.
- Follow-Up Measurements: Blood testosterone levels should be checked at 3-6 weeks after starting therapy, and then every 6 months thereafter.
- Adjustments: Based on these results, your doctor may adjust the dosage to
maintain appropriate testosterone levels. - Please obtain blood work between 12 to 18 hours after your most recent dose. For example, if you use testosterone in the morning, please have your blood work drawn at the end of the day just before the lab closes; if you use testosterone at night, please have your blood drawn the following day at mid-late morning or just before lunch.
What should I do if I miss a dose?
If you miss a dose, apply the missed dose as soon as you remember. If it is almost time for the next scheduled dose, then skip the missed dose and resume the regular dosing schedule. Do not apply a double dose to make up for the missed one. This approach helps maintain stable testosterone levels and minimizes the risk of side effects associated with fluctuating hormone levels.
References
- Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Davis SR, Baber R, Panay N, et al. The Journal of Clinical Endocrinology and Metabolism. 2019;104(10):4660-4666. doi:10.1210/jc.2019-01603.
- Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen. Davis SR, Moreau M, Kroll R, et al. The New England Journal of Medicine. 2008;359(19):2005-17. doi:10.1056/NEJMoa0707302.
- Efficacy and Safety of Testosterone in the Management of Hypoactive Sexual Desire
Disorder in Postmenopausal Women. Davis SR, Braunstein GD. The Journal of Sexual
Medicine. 2012;9(4):1134-48. doi:10.1111/j.1743-6109.2011.02634.x.
