Testosterone patch: new drug. Don't use to stimulate women's sexual desire

(1) A new disorder, 'hypoactive sexual desire disorder' (HSDD), has recently been promoted, just around the same time as the market release of testosterone patches. (2) Clinical evaluation of the testosterone patches is mainly based on two trials lasting 24 weeks and including a total of 1095 women who had undergone bilateral ovariectomy and hysterectomy and were also taking oestrogen replacement therapy. The indications for ovariectomy were not reported. (3) The average number of 'satisfying sexual activities' was about 3 during the 4 weeks that preceded the trial. It only increased slightly, in absolute terms, in the testosterone group compared to the placebo group (about 5 versus 4) during the last 4 weeks of the trial. (4) Scores on some rating scales improved slightly in the testosterone group, but their clinical relevance is unknown. (5) Acne, hirsutism, hair loss and deepening of the voice occurred more frequently in women using testosterone patches than in women on placebo. In about 30% to 60% of affected women, these adverse effects failed to resolve on treatment cessation. (6) The trials were too short to assess potential long-term risks, especially risks of cardiovascular events and cancer, in women who are also using oestrogen replacement therapy. (7) In practice, the risks associated with testosterone do not justify its use, particularly since the benefits are uncertain and at best modest. Sexual desire is governed by complex mechanisms. It is better to help women to understand and deal with the sources of their dissatisfaction than to expose them to the adverse effects of hormone therapy.