CLINICAL QUESTION

Is topical testosterone safe and effective for sexual function and vaginal symptoms in menopausal and postmenopausal women?

EVIDENCE-BASED ANSWER

Topical testosterone can be used to manage sexual function and vaginal symptoms associated with menopause. (Strength of Recommendation: B, systematic review and meta-analysis.) Combined with estrogen replacement therapy, topical testosterone increases the number of satisfying sexual episodes compared with placebo.

EVIDENCE SUMMARY

A 2017 systematic review and meta-analysis (N = 3,035) analyzed results from seven randomized controlled trials (RCTs) studying the effects of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder.¹ The primary outcome was the number of satisfying sexual episodes. In five studies, the testosterone group had significantly more satisfying sexual episodes than the placebo group. There was no difference in outcomes between women taking estrogen with or without progestin as hormone replacement therapy combined with transdermal testosterone and women using transdermal testosterone alone. In the pooled data, significantly more acne was noted in the testosterone group, but there were no differences in facial hair, voice deepening, alopecia, or lipid or metabolic profiles. Also, there were no differences in total or severe adverse effects.