What is the role of testosterone in women?

Made primarily in the ovaries and later in life, by the adrenal glands, testosterone is the primary hormone in women during their 20s and 30s yet, that hormone follows a downward trajectory beginning in our late 30s. This loss of testosterone can lead to hypoactive sexual desire disorder (HSDD). Studies reveal that about 12-26% of all U.S. women between the ages of 45-64 have HSDD. This is often described by women as a loss of sexual thoughts, changes in orgasm, loss of ability to have an orgasm by any means, or no desire to engage in sexual acts. Women presenting with this complaint require a wholistic approach to assessment that includes, sociocultural, biological, psychological, and interpersonal contributing factors. Also, a physical and gynecological exam with lab testing may be helpful in determining all contributing factors.

While testosterone is known to modulate sexual behavior, the serum levels do not corelate with HSDD. Providing transdermal testosterone therapy, dosed in a normal premenopausal range, has been found to improve sexual distress related to HSDD as well as sexual response and arousal. It is available as a manufactured cream, 5mg in 0.5ml dose, rubbed to the inner upper arms or thighs daily.  Signs of testosterone overdose are acne, voice deepening, or enlargement of the clitoris as well as hair loss. While  FDA has not approved testosterone for the treatment of HSDD, there have been no observed adverse events with its use in low doses.  Safety data is not available from current studies over the long-term. Sexual distress related to HSDD should have a positive response in 4-8 weeks of testosterone therapy. If no positive outcomes in HSDD-related symptoms after 12-weeks of use are observed, therapy should be stopped.