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.


METHODS
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.


METHODS
Literature review.


METHODS
Not applicable.


METHODS
Not applicable.


METHODS
Not applicable.


RESULTS
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.


CONCLUSIONS
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.
Schover
Leslie R
LR
Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230-1439, USA. lschover@mdanderson.org
D000328:Adult; D000368:Aged; D000728:Androgens / Q000009:adverse effects* / Q000378:metabolism; D001943:Breast Neoplasms / Q000139:chemically induced*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007989:Libido / Q000187:drug effects*; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism; D018579:Patient Selection; D010809:Physical Fitness; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D020018:Sexual Dysfunctions, Psychological / Q000188:drug therapy* / Q000378:metabolism; D013739:Testosterone / Q000009:adverse effects* / Q000378:metabolism; D016896:Treatment Outcome
D000728:Androgens; D013739:Testosterone