Abstract
PurposeTo explore the effects of 6-month systemic testosterone (T) administration on clitoral color Doppler ultrasound (CDU) parameters in women with female sexual dysfunction (FSD).Methods81 women with FSD were retrospectively recruited. Data on CDU parameters at baseline and after 6 months with four different treatments were available and thus further longitudinally analyzed: local non-hormonal moisturizers (NH group), n = 37; transdermal 2% T gel 300 mcg/day (T group), n = 23; local estrogens (E group), n = 12; combined therapy (T + E group), n = 9. Patients underwent physical, laboratory, and genital CDU examinations at both visits and completed different validated questionnaires, including the Female Sexual Function Index (FSFI).ResultsAt 6-month visit, T therapy significantly increased clitoral artery peak systolic velocity (PSV) when compared to both NH (p < 0.0001) and E (p < 0.0001) groups. A similar increase was found in the T + E group (p = 0.039 vs. E). In addition, T treatment was associated with significantly higher FSFI desire, pain, arousal, lubrication, orgasm, and total scores at 6-month visit vs. baseline. Similar findings were observed in the T + E group. No significant differences in the variations of total and high-density lipoprotein-cholesterol, triglycerides, fasting glycemia, insulin and glycated hemoglobin levels were found among the four groups. No adverse events were observed.ConclusionIn women complaining for FSD, systemic T administration, either alone or combined with local estrogens, was associated with a positive effect on clitoral blood flow and a clinical improvement in sexual function, showing a good safety profile.Trial registration numberNCT04336891; date of registration: April 7, 2020.
Highlights
Female sexual dysfunction (FSD) is a multifactorial condition in which organic, relational, and psychosocial factors are deeply intertwined
A subtle and progressive age-dependent decline of androgen levels has been implicated in the pathogenesis of both Hypoactive Sexual Desire Disorder (HSDD) [1] and Genitourinary Syndrome of Menopause (GSM) [2], whose prevalence increases with age [3, 4]
No significant association was observed between TT, DHEAS, A4, or cFT with genital color Doppler ultrasound (CDU) parameters
Summary
Female sexual dysfunction (FSD) is a multifactorial condition in which organic, relational, and psychosocial factors are deeply intertwined. In 2014, the Endocrine Society Clinical Practice Guideline recommended against making a clinical diagnosis of androgen deficiency syndrome in healthy women, since there is a lack of well-defined criteria [5], as opposed to men [6]. Postmenopausal women reporting low sexual desire have represented the main study population so far taken into account to demonstrate that female sexual function is a target of androgen action [5]. According to the definition of HSDD developed by the International Society for the Study of Women Sexual Health (ISSWSH) nomenclature committee, this condition can manifest as any of the following for a minimum of 6 months: lack of motivation for sexual activity (decreased/absent spontaneous or reactive to erotic stimulation desire); loss of desire to initiate or participate in sexual activity not as a consequence of sexual pain disorders; combination with clinically significant personal distress [1]. It has been reported that T treatment significantly influences multiple domains of sexual functioning, by improving desire, arousal, lubrication, pain, orgasm, and satisfaction [8,9,10,11]
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