Androgen therapy for loss of desire in women: is the benefit worth the breast cancer risk?

Objective

To contrast the limited evidence that androgen therapy is an effective treatment for low sexual desire in women with the extensive literature suggesting that androgens promote breast cancer.

Design

Evidence from population studies of women is reviewed on the association between endogenous androgen levels and sexual function or satisfaction. Recent randomized trials of testosterone therapy for low desire are critiqued in terms of methodology and generalizability. Research on endogenous testosterone levels and breast cancer risk in both premenopausal and postmenopausal women is summarized, as are recent studies of androgenic hormonal therapy and breast cancer risk.

Setting

Literature review.

Patient(s)

Not applicable.

Intervention(s)

Not applicable.

Main Outcome Measure(s)

Not applicable.

Result(s)

Endogenous androgen levels are not correlated with sexual desire in population-based studies of aging women. Factors that are strongly associated with low desire include pain with sexual activity, emotional distress, life stress, and relationship conflict. The efficacy of testosterone therapy for women's desire problems is modest. Expectancy effects were not adequately controlled in randomized trials. Epidemiological findings agree that higher endogenous serum androgen levels confer increased breast cancer risk both before and after menopause. Androgenic hormonal replacement regimens also increase the risk of breast cancer.

Conclusion(s)

Testosterone supplementation should not be prescribed to women with low sexual desire unless long-term studies can demonstrate its efficacy and safety. Treatments for low sexual desire in women should address its common correlates: relationship distress, emotional distress, and dyspareunia.

Key Words: Testosterone, androgens, breast cancer, hypoactive sexual desire disorder, hormonal therapy