(091) Testosterone Therapy for Female Sexual Dysfunction: A Systematic Review of the Literature Demonstrating Outcomes in Premenopausal and Postmenopausal Women

Abstract Introduction Testosterone therapy is increasingly used for the treatment of female sexual dysfunction (FSD), particularly hypoactive sexual desire disorder (HSDD). While evidence and guidelines support its use in postmenopausal women, its role in premenopausal populations remains less clear. Clarifying how menopausal status influences treatment response is essential for optimizing individualized care. Objective To systematically assess the effectiveness of testosterone replacement therapy (TRT) for FSD in premenopausal and postmenopausal women, with specific attention to improvements in libido, sexual satisfaction, and related outcomes. Methods A systematic review was conducted following PRISMA guidelines. Databases searched included Scopus (n = 565), PubMed (n = 186), and CINAHL (n = 31), yielding 782 records. After removal of duplicates (n = 230) and screening (n = 552), a total of 32 studies were included. Studies were eligible if they evaluated TRT in pre- or postmenopausal cisgender women with FSD and reported relevant sexual function outcomes. Study quality and design were considered in the synthesis, and subgroup analysis by menopausal status was performed. Results Among the 32 included studies, 4 RCTs involved premenopausal women and 6 high-quality studies (including RCTs and reviews) involved postmenopausal women. In premenopausal populations, transdermal and vaginal testosterone therapies were associated with improved libido, frequency of satisfactory sexual events, and sexual satisfaction. Sample sizes in these trials ranged from 10 to 261. In postmenopausal cohorts, large-scale RCTs (including one with 800 participants) demonstrated significant improvements in sexual desire and HSDD symptoms with transdermal testosterone (300 μg/day). Benefits were consistent across studies, although androgen levels and long-term safety data were inconsistently reported. Conclusions TRT is effective for improving key aspects of sexual function in both premenopausal and postmenopausal women. The strongest evidence exists for postmenopausal women, where randomized trials show robust benefit and support guideline-based use. For premenopausal women, preliminary evidence is promising but limited by smaller sample sizes and fewer trials. Further high-quality studies are needed to establish optimal indications, dosing, and safety in this younger cohort. Disclosure No.