Testosterone and Decreased Sexual Desire

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Decreased sexual desire (Hypoactive Sexual Desire Disorder, HSDD) or low libido is common after natural or surgical menopause. Numerous studies have suggested that low dose testosterone worn as a patch and currently marketed in the UK as Intrinsa® has benefit in the treatment of HSDD. Recent data from the Aphrodite Study in which women, not on hormone replacement, were randomized to either the testosterone patch or a placebo patch for an initial 24 weeks demonstrated significant improvements in the frequency of satisfying sexual episodes for those women on testosterone. This included an increase in sexual desire, arousal, orgasm and pleasure along with a reduction in personal distress. The testosterone patch was well tolerated except for a higher incidence of hair growth. During the study four patients in the testosterone patch group were diagnosed with breast cancer introducing a possible causal relationship with breast cancer.
Currently there is no FDA drug approved for the treatment of decreased sexual desire in the US. Low libido is a complex subject and sometimes a difficult subject to discuss. The different types of female sexual dysfunctional, namely problems with desire, arousal, orgasm or pain should be differentiated from each other during a careful evaluation by a health care provider with expertise in this area. It is estimate that anywhere from 9 to 40% of women experience some form of female sexual dysfunction.
SJ Wininger, MD, FACOG

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Doctor discusses symptoms of Female Decreased Desire or HSDD

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Female Decreased Desire or HSDD
Hypoactive (decreased) sexual desire disorder or HSDD is characterized by a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal problems (problems within a relationship). It is not simply a loss of libido which is a term that belittles the complexity of sexual relationships.  Decreased desire can however be further categorized as gradual onset or lifelong. Gradual onset means that at some point in time a woman who had or experienced a fulfilling sexual life began to loose some or all interest or desire for sexual activity. Lifelong on the other hand is someone who reports never having had sexual fantasies or a desire for sexual activity ever.. There are also women who have situational decreased desire i.e. (parents-in law spend the weekends) versus those with decreased desire that is generalized and unrelated to any set of circumstances.
 
The hallmark of the disorder is that by definition the loss or decrease in desire causes personal distress and/or creates problems within a relationship. Often partners/spouses of those affected believe that they are no longer desired or loved when often times just the opposite exists. Many women feel guilty or inadequate and feel that there is something the matter with them. Some women fulfill their partners desire for sex simply for the sake of protecting their relationship yet they feel no desire for sex, never initiate foreplay or experience sexual fantasies.In some cases relationships become completely jeopardized.

Approximately 10-20% of women suffer from this disorder in the US and there is presently no approved treatment available. Testosterone in a transdermal (patch) delivery system is available in Europe for the treatment of decreased or absent desire in post-menopausal women. To date, the patch however has not been approved for use  in the USA

-SJ Wininger,MD

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