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When we think of the hormone testosterone, we tend to think of it as only a “male” hormone. But women’s ovaries produce small amounts of testosterone in addition to larger amounts of the “female” hormone estrogen. When premenopausal women have their ovaries surgically removed, a procedure known as an oophorectomy, they often do not “feel right” and report symptoms of sexual dysfunction despite estrogen replacement therapy. In the Sept. 7 issue of the New England Journal of Medicine, a study examines the effects of administering testosterone to women who have impaired sexual function after surgically induced menopause.

Researchers led by Jan L. Shifren, M.D., of Massachusetts General Hospital, hypothesized that symptoms of sexual dysfunction, such as a lack of sexual interest, reported by premenopausal women who underwent oophorectomy, might be reversed with testosterone replacement. They found that administration of testosterone in these women did improve their sexual function and psychological well-being.

The ovaries’ estrogen production drops dramatically when a woman enters menopause. The drop in testosterone production is not as great. However, if the ovaries are removed prior to menopause — called surgical menopause — there is a much greater reduction in testosterone levels than for a woman who has gone through natural menopause.

In the recent study, researchers studied 75 healthy women, aged 31 to 56, at different sites in the United States. The women had undergone oophroectomies before natural menopause and had below-normal blood levels of testosterone. All subjects had received daily doses of estrogen for at least two months and were in stable heterosexual relationships.

Before enrollment, the women completed the Brief Index of Sexual Functioning for Women. This multiple-choice questionnaire was used to assess aspects of the subjects’ sexuality, such as relationship satisfaction, frequency of sexual activity, and sexual desire. To qualify for the study, women had to have a score of less than normal.

Each subject received a different regimen of testosterone skin patches for 12 weeks at a time. The combinations included: two placebo patches (no testosterone); one placebo and one testosterone patch (150 micrograms per day); and two testosterone patches (300 micrograms per day). Blood levels of testosterone were measured at baseline and at weeks four, eight and 12 of each treatment period. Additionally, the sexuality questionnaire was repeated at week 12 of each treatment period and subjects’ moods were assessed with the Psychological General Well-Being Index questionnaire.

The results showed that the testosterone blood levels were low to low-normal during placebo treatment, increased to mid-normal levels with the 150-microgram patch, and exceeded normal ranges with the 300-microgram patch. The higher testosterone dosage resulted in further boosts in scores from the Brief Index of Sexual Functioning. Other findings were that hair growth and acne did not change significantly for women during treatment.

The authors noted that just being in the study might have influenced the subjects’ behavior. For instance, study participation alone might have facilitated communication between couples, or the visible skin patch might have served as a stimulus to increase their sexual activity.

There are still unanswered questions concerning the clinical use of the testosterone patch in women with impaired sexual function. In an accompanying editorial, Drs. David Guzick and Kathleen Hoeger of the University of Rochester Medical Center note that the long-term daily use of 300 micrograms of testosterone, which produced a higher-than-normal blood level of testosterone, might have side effects. Further, the study did not include women who were taking antidepressant drugs, possibly due to their sexual dysfunction, but which might have significant drug interactions with the administration of testosterone.

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