Exploring Testosterone Therapy Trends in Treating Hypoactive Sexual Desire Disorder (HSDD) in Women

Hypoactive sexual desire disorder (HSDD) is a condition affecting many women, characterized by a low libido that causes distress. It’s well-known that low testosterone levels can lead to reduced libido in men, and testosterone therapy (TTh) can effectively address this issue. Interestingly, TTh has also shown promise in treating HSDD in women, particularly postmenopausal women, by enhancing sexual function and satisfaction.

However, the use of testosterone therapy in women is not yet approved by the Food and Drug Administration (FDA) due to limited research on the different formulations and delivery methods available, such as oral, transdermal patches, topical gels, and injectables. Additionally, the long-term effects of TTh in younger women remain unknown, necessitating further longitudinal studies before it can be widely recommended for this group.

Physicians also face challenges in managing female sexual dysfunction, such as lack of confidence in treatment options and time constraints. A new study aims to understand the current trends in prescribing testosterone therapy for women with HSDD in the U.S., providing insights into how this condition is being managed today.

Methods

Researchers used electronic health records from the TriNetX Diamond research network to analyze trends in testosterone prescriptions for women with HSDD from 2009 to 2022. The study focused on women aged 18-70 diagnosed with HSDD. Individuals with certain medical histories, such as intersex surgery or sex reassignment, and those with a testosterone prescription before their HSDD diagnosis, were excluded.

The analysis looked at the frequency of testosterone prescriptions, the methods of administration, and whether testosterone was prescribed alongside estrogen. Incidence rates and prevalence were calculated over specific time intervals from 2012 to 2020, examining the following age groups: 18-40 years (premenopausal), 41-55 years (perimenopausal), and 56-70 years (postmenopausal). Statistical tests assessed the significance of the findings.

Results

From the analysis, 33,418 women were diagnosed with HSDD, and 573 received their first testosterone prescription within six months of diagnosis at an average age of 47.8 years. Over a three-year period following HSDD diagnosis, 761 women received testosterone prescriptions, with varying frequencies. Injectable testosterone was the most commonly prescribed form, followed by topical and pellet forms. Often, testosterone was prescribed alongside estrogen.

Postmenopausal women had the highest prevalence of testosterone prescriptions, while premenopausal women had the lowest. A notable decline in prescription rates occurred around late 2015, but an overall increasing trend in prevalence was observed afterward.

Discussion & Conclusion

The study highlights trends in prescribing testosterone therapy for women with HSDD. Only 2.5% of women with HSDD received TTh, with wide variations in the duration, method of administration, and coadministration with estrogen, indicating a lack of standardized guidelines.

Despite an increase in the prevalence of TTh prescriptions since 2015, long-term adherence remained low. This may be due to patients finding the therapy unsatisfactory or discontinuing it before seeing benefits due to unclear treatment guidance.

Factors influencing TTh use include conflicting evidence on safety, lack of FDA-approved formulations for women, insurance coverage limitations, and patient compliance issues. The absence of research on the potential long-term effects of TTh in young women also likely deters providers from prescribing it to this group.

Further research is essential to establish the safety, efficacy, and optimal duration of TTh for treating HSDD and to address disparities in its management. Collaboration among researchers, clinicians, regulatory bodies, and advocacy organizations is crucial for advancing our understanding and treatment of this condition.

References:

• ISSM
• Agrawal, P., Lee, Y. S., Grutman, A. J., Dumas, K., Kohn, T., Kohn, J., Yee, A. M., & Clifton, M. (2024). Characteristics of systemic testosterone therapy for female hypoactive sexual desire disorder—a claims database analysis. The Journal of Sexual Medicine, 21(4), 288–293. https://doi.org/10.1093/jsxmed/qdae013