Testosterone therapy (TTh) prescription among women with hypoactive sexual desire disorder (HSDD) has significant variation in duration, route, and co-administration with estrogen patterns, according to a recent study published in the Journal of Urology.1
Takeaways
- The study uncovers significant diversity in testosterone therapy (TTh) prescriptions among women diagnosed with hypoactive sexual desire disorder (HSDD).
- Results reveal varied administration routes for TTh, including injectable, topical, and pellets, indicating a lack of consensus on the most effective delivery method.
- A subset of women received TTh alongside estrogen, suggesting potential complexities in treatment approaches and hormone interactions that warrant further investigation.
- While there was a positive trend in TTh prevalence for HSDD until September 1, 2015, a subsequent reduction in prescriptions was observed, indicating potential shifts in clinical practices over time.
- Despite being recommended, TTh was prescribed to only 2.5% of women with HSDD, underscoring the underutilization of this treatment option.
Women with HSDD experience a loss of sexual desire for 6 months or longer, which can lead to significant personal distress.2 Approximately 10% of women are impacted by HSDD, with symptoms including decreased spontaneous sexual thoughts, decreased response to stimuli, failure to maintain interest through sex, and loss of sexual initiation desire.
TTh has not received approval for the treatment of HSDD by the FDA despite being a recommended treatment method.1 Additionally, sexual dysfunction is complex in nature, leading to few interventions.
A lack of clinical knowledge about the biological factors related to sexual desire also increase difficulty in diagnosing and treating HSDD.2 Patients may also feel hesitation toward discussing their sexual desire with physicians. However, low sexual desire has been estimated in at least 16 million women aged 50 years or older.
Sex therapy and medications are currently used to treat women with HSDD. However, flibanserin is the only drug with FDA approval to treat the condition in premenopausal women.
To evaluate TTh prescribing patterns for improved understanding of HSDD in women, investigators conducted a cohort analysis with multiple hypothesized barriers to TTh prescription among women with this condition.1 Participants included women aged 18 to 70 years diagnosed with HSDD using TriNetX Diamond.
Exclusion criteria included intersex surgery, personal sex reassignment history, gender identity disorder, and TTh before first HSDD diagnosis. Data included TTh prescription trends, administration routes, and co-administration with estrogen. Additionally, sub-group analyses based on age were performed.
There were 33,418 women with an HSDD diagnosis included in the analysis. Participants were diagnosed with HSDD when aged a mean 44.2±10.8 years. TTh was given to 850 individuals, 378 of whom received 1 prescription, 195 2 to 3 prescriptions, 161 4 to 9 prescriptions, and 116 more than 10 prescriptions.
An injectable testosterone prescription was reported in 461 women, a topical testosterone prescription in 257, and a pellets prescription in 119. Co-prescription estrogen was reported in 162 women.
All age groups had a positive quadratic trend in TTh for HSDD until September 1, 2015. After this time, a significant reduction in TTh prevalence was observed compared to the expected trend.
A positive linear trend in prevalence was reported following September 1, 2015, with a slope of 0.0005 for the overall population. This slope was 0.0004 for patients aged 18 to 40 years, 0.0004 for those aged 56 to 70 years, and 0.0009 for those aged 41 to 55 years.
These results indicated TTh prescriptions among 2.5% of women with HSDD. The duration, route, and co-administration with estrogen patterns also varied significantly. Investigators concluded there is a crucial need to research treatment mechanisms, efficacy, and long-term outcomes.
References
- MP47-04 Examining the trends in testosterone therapy for women with hypoactive sexual desire disorder. Journal of Urology. 2024;211(55):e763. doi:10.1097/01.JU.0001008880.11564.10.04
- Hypoactive sexual desire disorder (HSDD) in women. University of Colorado. Accessed May 7, 2024. https://obgyn.coloradowomenshealth.com/health-info/conditions/hypoactive-sexual-desire-disorder
