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Does testosterone work in loss of libido due to tamoxifen?

Professor Peter Bowen-Simpkin's Need to Know on Managing the Menopause prompted Dr Geraldine Badger to ask her own question.

Professor Peter Bowen-Simpkin's Need to Know on Managing the Menopause prompted Dr Geraldine Badger to ask her own question.

Is the testosterone patch a potential treatment for loss of libido in patients on tamoxifen for oestrogen-receptor positive breast cancer, as this seems to work by "chemical oophorectomy"? What are the potential risks of this treatment in this group of patients?

This is an interesting question as loss of libido is a common problem on tamoxifen. Intrinsa (a transdermal testosterone patch) has a licence for women who have had a surgical menopause. To use it, patients have to be taking oestrogen. The latter increases SHBG levels and binds a proportion of free testosterone. In the scenario mentioned, the patient presumably has an intact uterus and ovaries. Tamoxifen works by blocking the receptor sites for oestrogen in breast tissue (as an antagonist) rather than stopping oestrogen production by the ovaries and so is not really analogous to chemical oophorectomy. It has agonistic actions on the endometrium and cardiovascular systems.

Patients on tamoxifen have been treated with HRT for relief of their menopausal symptoms without any apparent adverse effect (anecdotal evidence) and therefore could have added testosterone, but this is entirely outside the licensed use of the product. Tamoxifen has not been shown to have any effect on testosterone levels1 and little effect on oestrogen levels in the post menopausal woman and in the case sited, the patient is likely to have normal testosterone and SHBG levels for her age

Loss of libido is often due to vaginal dryness and dyspareunia (common symptoms whilst taking tamoxifen). This can be treated with topical vaginal oestrogens which are not systemically absorbed.


Mr Peter Bowen-Simpkins is consultant obstetrician and gynaecologist at Singleton Hospital, Swansea, and a council member of the Royal College of Obstetricians and Gynaecologists

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