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Previous Volume 343:682-688 September 7, 2000 Number 10 Next

	Full Text PDF Editorial by Guzick, D. S. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The ovaries provide approximately half the circulating testosterone 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 function after surgically induced menopause.

Methods Seventy-five women, 31 to 56 years old, who had undergone oophorectomy and hysterectomy received conjugated equine estrogens (at least 0.625 mg per day orally) and, in random order, placebo, 150 µg of testosterone, and 300 µg of testosterone per day transdermally for 12 weeks each. Outcome measures included scores on the Brief Index of Sexual Functioning for Women, the Psychological General Well-Being Index, and a sexual-function diary completed over the telephone.

Results The mean (±SD) serum free testosterone concentration increased from 1.2±0.8 pg per milliliter (4.2±2.8 pmol per liter) during placebo 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 treatment with 150 and 300 µg 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 further increases in scores for frequency of sexual activity and pleasure–orgasm 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 least once a week increased two to three times from base line. The positive-well-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, transdermal testosterone improves sexual function and psychological well-being.

Source Information

From the Vincent Memorial Obstetrics and Gynecology Service, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston (J.L.S.); the Department of Medicine, Cedars–Sinai Medical Center, Los Angeles (G.D.B.); Women's Health Research Center, Laurel, Md. (J.A.S.); the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston (P.R.C., J.E.B.); the Foundation for Developmental Endocrinology, Cleveland (G.P.R.); Salt Lake City (R.E.B.); the Center for Reproductive Medicine, Brigham and Women's Hospital, Boston (E.S.G.); the Department of Psychiatry, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, Piscataway (R.C.R., S.R.L.); and the Department of Clinical Research, Watson Laboratories–Utah, Salt Lake City (K.E.C., N.A.M.). Other authors were Kirtley P. Jones, M.D. (Department of Obstetrics and Gynecology, University of Utah Medical Center, Salt Lake City), and Claire A. Daugherty, M.S. (Anesta Corporation, Salt Lake City).

Address reprint requests to Dr. Shifren at Vincent Memorial Obstetrics and Gynecology Service, VBK-113, Massachusetts General Hospital, Boston MA 02114, or at janshifren{at}hotmail.com.

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• Lightner, D. J. (2002). Female Sexual Dysfunction. Mayo Clin Proc. 77: 698-702 [Abstract]  
• Johannsson, G., Burman, P., Wiren, L., Engstrom, B. E., Nilsson, A. G., Ottosson, M., Jonsson, B., Bengtsson, B.-A., Karlsson, F. A. (2002). Low Dose Dehydroepiandrosterone Affects Behavior in Hypopituitary Androgen-Deficient Women: A Placebo-Controlled Trial. J. Clin. Endocrinol. Metab. 87: 2046-2052 [Abstract] [Full Text]  
• Mukherjee, T. K., Dinh, H., Chaudhuri, G., Nathan, L. (2002). Testosterone attenuates expression of vascular cell adhesion molecule-1 by conversion to estradiol by aromatase in endothelial cells: Implications in atherosclerosis. Proc. Natl. Acad. Sci. USA 99: 4055-4060 [Abstract] [Full Text]  
• Fishman, J. R. (2002). Sex, Drugs, and Clinical Research. Mol. Interv. 2: 12-16 [Full Text]  
• Baumeister, R. F., Catanese, K. R., Vohs, K. D. (2001). Is There a Gender Difference in Strength of Sex Drive? Theoretical Views, Conceptual Distinctions, and a Review of Relevant Evidence. Pers Soc Psychol Rev 5: 242-273 [Abstract]  
• Miller, K. K. (2001). Androgen Deficiency in Women. J. Clin. Endocrinol. Metab. 86: 2395-2401 [Abstract] [Full Text]  
• Snyder, P. J. (2001). Editorial: The Role of Androgens in Women. J. Clin. Endocrinol. Metab. 86: 1006-1007 [Full Text]  
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