Transdermal testosterone treatment in women with impaired sexual function after oophorectomy

Background The ovaries provide approximately half the circulating testoster one in premenopausal women. After bilateral oophorectomy, many women report impaired sexual functioning despite estrogen replacement. We evaluated the effects of transdermal testosterone in women who had impaired sexual funct ion after surgically induced menopause. Methods Seventy-five women, 31 to 56 years old, who had undergone oophorect omy and hysterectomy received conjugated equine estrogens (at least 0.625 m g per day orally) and, in random order, placebo, 150 mu g of testosterone, and 300 mu g of testosterone per day transdermally for 12 weeks each. Outco me measures included scores on the Brief Index of Sexual Functioning for Wo men, the Psychological General Well-Being Index, and a sexual-function diar y completed over the telephone. Results The mean (+/- SD) serum free testosterone concentration increased f rom 1.2 +/- 0.8 pg per milliliter (4.2 +/- 2.8 pmol per liter) during place bo treatment to 3.9 +/- 2.4 pg per milliliter (13.5 +/- 8.3 pmol per liter) and 5.9 +/- 4.8 pg per milliliter (20.5 +/- 16.6 pmol per liter) during tr eatment with 150 and 300 mu g of testosterone per day respectively (normal range, 1.3 to 6.8 pg per milliliter [4.5 to 23.6 pmol per liter]). Despite an appreciable placebo response, the higher testosterone dose resulted in f urther increases in scores for frequency of sexual activity and pleasure or gasm in the Brief Index of Sexual Functioning for Women (P = 0.03 for both comparisons with placebo). At the higher dose, the percentages of women who had sexual fantasies masturbated, or engaged in sexual intercourse at leas t once a week increased two to three times from base line. The positive-wel l-being, depressed-mood, and composite scores of the Psychological General Well-Being Index also improved at the higher dose (P = 0.04, P = 0.03, and P = 0.04, respectively, for the comparison with placebo), but the scores on the telephone-based diary did not increase significantly. Conclusions In women who have undergone oophorectomy and hysterectomy trans dermal testosterone improves sexual function and psychological well-being. (N Engl J Med 2000; 343: 682-8.) (C) 2000, Massachusetts Medical Society.