Introduction

Hypoactive sexual desire disorder (HSDD) is a medical condition that affects many women, causing low libido and distress. It has been established that low levels of testosterone can cause low libido in men, and testosterone therapy (TTh) can be an effective treatment option. Testosterone therapy has also shown promise in treating HSDD in women, especially postmenopausal women, improving sexual function and satisfaction.

Nevertheless, its use in women is not approved by the Food and Drug Administration (FDA) due to limited research on the available formulations and delivery systems (oral, transdermal patch, topical gel, injectable). Additionally, the possible long-term effects of testosterone therapy in young women are unknown, so longitudinal research is necessary to determine this before TTh can be recommended as a treatment for this population.

Furthermore, physicians may face other challenges in addressing female sexual dysfunction, such as lack of confidence in treatments and time constraints. Therefore, a new study aimed to understand the current trends in prescribing TTh for women with HSDD in the U.S., shedding light on the management of this condition at this point in time.

Methods

For this study, the researchers used electronic health records from TriNetX Diamond, a real-world data research network, to analyze trends in testosterone prescriptions for women with HSDD. The data spanned from 2009 to 2022, focusing on women aged 18-70 with HSDD. Exclusions were made for individuals with certain medical histories, such as a diagnosis of intersex surgery female to male, a personal history of sex reassignment, and those with a prescription for testosterone before their HSDD diagnosis.

The authors analyzed the frequency of testosterone prescriptions, how testosterone was administered, and if it was given with estrogen. Incidence rates and prevalence were calculated over time intervals from 2012 to 2020. The following age groups were examined: 18-40 years (premenopausal), 41-55 years (perimenopausal), and 56-70 years (postmenopausal). Statistical tests were used to assess significance.

Results

Upon analyzing the data, the researchers found that out of 33,418 women diagnosed with HSDD, 573 received their first testosterone prescription within 6 months of their diagnosis at an average age of 47.8 years. Over a 3-year period after HSDD diagnosis, 761 women received testosterone prescriptions, with varying prescription frequencies. Injectable testosterone was the most common form, followed by topical and pellet forms. Testosterone was often prescribed with estrogen.

Postmenopausal women had the highest prevalence of testosterone prescriptions, while premenopausal women had the lowest. There was a notable decline in prescription rates around late 2015. Despite fluctuations, there was an overall increasing trend in prescription prevalence after this time period.

Discussion & Conclusion

The researchers’ findings shed light on TTh prescribing trends for women with HSDD. While 2.5% of women with HSDD received TTh, the patterns varied widely in duration, route, and coadministration with estrogen, suggesting a lack of standardized guidelines.

Long-term adherence to TTh remained low despite its increased prevalence since 2015. Based on these results, the authors theorize that patients may find therapy unsatisfactory or discontinue it before experiencing benefits due to unclear treatment guidance.

According to the authors, factors influencing TTh use may include conflicting evidence on safety, lack of FDA-approved formulations for women, insurance coverage limitations, and patient compliance issues. The lack of research and clear information on the potential long-term effects of testosterone therapy use in young women is likely another deterrent for providers to prescribe it to this group of patients. Therefore, further research is needed to establish the safety, efficacy, and optimal duration of TTh for this purpose, as well as to address disparities in HSDD management. This will require collaboration among researchers, clinicians, regulatory bodies, and advocacy organizations.

References:

• 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