FPIN's Clinical Inquiries

Treatments for Postmenopausal Hypoactive Sexual Desire Disorder


Am Fam Physician. 2020 Feb 1;101(3):182-183.

Clinical Question

How effective are treatments for women with postmenopausal hypoactive sexual desire disorder (HSDD)?

Evidence-Based Answer

Transdermal testosterone for the treatment of HSDD in postmenopausal women results in an additional 0.92 sexually satisfying events (SSEs) per month, acne, and increased androgenic effects without major complications. (Strength of Recommendation [SOR]: A, based on a meta-analysis of high-quality randomized controlled trials [RCTs].) Women treated with flibanserin (Addyi) had increases in SSEs (0.4 additional per month, or approximately one SSE every 2.5 months) and sexual function, with increased dizziness, somnolence, and nausea. (SOR: B, based on a meta-analysis of low-quality RCTs.) The use of dehydroepiandrosterone (DHEA) improved sexual function in women with HSDD. (SOR: B, based on a meta-analysis of low-quality RCTs.)


A 2017 meta-analysis of seven double-blind RCTs (N = 3,035) evaluated the safety and effectiveness of transdermal testosterone in postmenopausal women with HSDD.1 Women 20 to 70 years of age who were naturally or surgically menopausal, with or without hormone therapy using estrogen and/or progesterone, were given transdermal testosterone, 150 to 450 mcg per day for 24 weeks. Compared with those who received placebo, women treated with testosterone had more SSEs per month (five studies; mean difference [MD] = 0.92; 95% CI, 0.65 to 1.19; P < .00001). More SSEs were experienced by postmenopausal women receiving hormone therapy and testosterone (four studies; MD = 0.96; 95% CI, 0.50 to 1.42; P < .0001) or testosterone without hormone therapy (one study; MD = 1.40; 95% CI, 0.68 to 2.12; P = .0001). Testosterone therapy was associated with increased desire (six studies; standardized MD = 6.09; 95% CI, 4.51 to 7.68; P < .00001); decreased personal distress as measured on the Female Sexual Distress Scale, with a score of 15 or greater indicating distress (four studies; standardized MD = −8.15; 95% CI, −10.60 to −5.70; P < .00001);

Address correspondence to José E. Rodriguez, MD, at jose.rodriguez@hsc.utah.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Achilli C, Pundir J, Ramanathan P, et al. Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder: a systematic review and meta-analysis. Fertil Steril. 2017;107(2):475–482.e415....

2. Jaspers L, Feys F, Bramer WM, et al. Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(4):453–462.

3. Scheffers CS, Armstrong S, Cantineau AE, et al. Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database Syst Rev. 2015;(1):CD011066.

4. Panjari M, Bell RJ, Jane F, et al. The safety of 52 weeks of oral DHEA therapy for postmenopausal women. Maturitas. 2009;63(3):240–245.

5. Bloch M, Meiboom H, Zaig I, et al. The use of dehydroepiandrosterone in the treatment of hypoactive sexual desire disorder: a report of gender differences. Eur Neuropsychopharmacol. 2013;23(8):910–918.

6. Clayton AH, Goldstein I, Kim NN, et al. The International Society for the Study of Women's Sexual Health process of care for management of hypoactive sexual desire disorder in women. Mayo Clin Proc. 2018;93(4):467–487.

7. Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(10):3489–3510.

8. North American Menopause Society. Clinical care recommendations: chapter 8: prescription therapies. Accessed November 5, 2019. http://www.menopause.org/publications/clinical-care-recommendations/chapter-8-prescription-therapies

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.



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