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Testosterone patch for female low libido

Q - Are testosterone patches for women with low libido better than oral treatment? Can they be given with HRT?

A - In the past three years good randomised controlled trials have clearly demonstrated a benefit in well-being and libido in women receiving testosterone after oophorectomy.

Consequently, it has become an acceptable strategy in hypogonadal women with low libido.

The difficulty now is that the repertoire of testosterone replacement products is very limited and, in the UK, none is primarily aimed at women.

Early studies used testosterone implants, which are limited by their long duration of action and potentially longlasting side-effects such as hirsutism or seborrhoea.

In contrast, oral testosterone (testosterone undecanoate) is limited by its very short half-life of five to six hours requiring multiple dosing.

There has been some progress in developing a transdermal delivery system for testosterone suitable for use in women.

One patch system, on which the recent RCT data was based, is still in development. The only patches available in the UK are not suitable for use in women.

Transdermal testosterone gel has recently become available in sachets designed for male dosage and this preparation may turn out to be a suitable option for women as long as local dermal changes do not accumulate.

Testosterone supplements are a useful addition to oestrogen replacement in selected cases. We still lack good preparations for women for whom the choice lies between oral, implant and gel preparations. In the absence of head-to-head comparisons among these, the shorter-acting preparations such as tablets or gel seem to be a good place to start.

Gerrard Conway is consultant endocrinologist at University College Hospital London

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