Testosterone and female sexuality: A skeptical view

Abstract

Loss of sexual interest is a common complaint that women mention to their doctors. Although previously, etiology was generally assumed to be psychological, current research has focused on possible organic factors. A prominent hypothesis is that testosterone is necessary for women’s sex drive, as it clearly is for men’s. This hypothesis is problematic for several reasons. Studies reporting lower levels of testosterone in women with lower sexual interest have not been randomized. Many women with low testosterone levels have full sexual interest and satisfaction. Although several studies have reported improved sexual interest with testosterone administration, testosterone levels have been supraphysiologic. Even so, many women do not respond. Evidence is lacking for a proposed "androgen deficiency syndrome," in which symptoms characteristic of depression are attributed to lack of testosterone. An additional concern is safety: testosterone excess in women has well-established adverse effects, including acne, hirsutism, alopecia, and, possibly, impaired carbohydrate metabolism. The role of testosterone in female sexuality needs further investigation before its widespread use can be recommended.