Testosterone and sexual desire in women

Sexual dysfunction, primarily low libido, is common among women. The prevalence appears to increase with age from the mid-20s and acutely following ovariectomy. There are multiple influences on libido and frequency and enjoyment of sexual activity in women. However, androgens appear to be important determinants of female sexual desire and low circulating levels are associated with diminished libido. The decline in physiological circulating androgen levels in women commences in the mid-20s, and androgen levels continue to fall in a manner unrelated to the menopause. Hence androgen insufficiency should be considered as a possible cause of low libido in premenopausal as well as postmenopausal women, and particularly in women who have experienced an iatrogenic menopause. We, and others, have demonstrated improvements in sexuality and well-being in postmenopausal women with testosterone therapy, over and above the effects of postmenopausal estrogen replacement given alone. Whether these clinical effects of testosterone therapy are physiological or pharmacological is not known.