Many women in their 40’s report loss of libido, lowered mood, and fatigue. This can happen because testosterone levels decline with age in premenopausal women such that women in their 40’s have nearly half the circulating levels of women in their 20’s. The levels may further decline with preceding age.
Existing studies showing the benefits of testosterone on sexual function are limited to postmenopausal women, but no data is available with regard to its benefits in premenopausal women.
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Study by the North American Menopause Society
The North American Menopause Society undertook a study to investigate the safety and efficacy of a physiological dose of testosterone, administered as a transdermal cream, on the overall well-being, sexual function, and mood in otherwise healthy premenopausal women who considered themselves to have low libido.
Women in the age group of 30 to 45, having a body mass index between 18 and 35 kg/m2, expressing diminished sexuality, and total testosterone of less than 2.2 nmol/L were chosen for the study. The protocol was a placebo controlled, crossover design with two double-blind, 12-week treatment periods separated by a single-blind, 4-week washout period. The participants were randomly assigned to the order in which they received testosterone or placebo treatment.
General Well-being Evaluation
Scientific scales were applied to assess the overall general well-being, including depressed mood, anxiety, self-confidence, positive well-being and general health, and vitality. Sexuality aspects were assessed for sexual interest, sexual activity, satisfaction of sexual life, experience of sexual pleasure, sexual fantasy, orgasm capacity, and sexual relevancy.
Safety Evaluation
Throughout the study, acne, voice changes, hirsutism, and any adverse events or changes in medication were recorded.
Results
Effect on Serum Hormone Levels
The mean serum total testosterone increase by 0.22 nmol/L with placebo and 1.54 nmol/L with testosterone. The FAI increased by 0.4 with placebo and 3.6 with testosterone. The mean values for total testosterone remained within the normal female reproductive range, whereas the mean FAI rose to above the upper limit of normal with testosterone treatment.
Effect on General Well-being, Mood and Sexual Function
Significant improvements of 12.9 and 15.7 units were seen on the composite scores for Psychological General Well-Being Index and Sabbatsberg Sexual Self-Rating Scale respectively with testosterone in the per protocol analysis. The beneficial effect of testosterone was seen for all subscale scores of the Psychological General Well-Being Index.
Inference
Substantial and clinically meaningful improvements in psychological and sexual well-being were demonstrated in this study with transdermal testosterone therapy in healthy premenopausal women who had a primary complaint of low libido.
The improvement in the composite score of the Sabbatsberg Sexual Self-Rating Scale was large and persisted even after four weeks of treatment washout. Nearly half of the women had a 50 percent improvement in their individual sexual function score. In summary, the study demonstrated significant efficacy of transdermal testosterone therapy in women in their mid to late reproductive years on well-being and sexual function.
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