Testosterone improves postmenopausal sex lives; long-term safety is untested

The consequences of falling oestrogen at menopause are well established, but testosterone's role through the menopause is far less clear. Sexual dysfunction is a common and distressing problem for postmenopausal women, and the treatment options on offer are limited. Testosterone is usually discussed as a male hormone, yet women produce it too, and a number of trials have tested whether giving it as therapy helps. Clinicians treating postmenopausal women have needed a clear, critical summary of what that evidence actually shows, which is what this review set out to provide.

The authors conducted a systematic review of randomised controlled trials investigating the efficacy and safety of testosterone therapy for female sexual dysfunction in postmenopausal women. They gathered the randomised, placebo-controlled trial literature and appraised it critically, looking at effects on sexual function alongside other reported outcomes such as bone mineral density and blood lipids. The stated aim was a concise and critical summary of the literature to guide clinicians treating postmenopausal women, rather than a single pooled statistical estimate.

Several randomised, placebo-controlled trials suggest that testosterone therapy improves sexual function in postmenopausal women. Some studies point to additional effects, including increased bone mineral density. The picture is not entirely positive, however: testosterone therapy was also linked to decreased serum HDL cholesterol, the fraction often described as protective. Crucially, the review found that the long-term safety profile of testosterone therapy in postmenopausal women is not clear, an absence of evidence rather than evidence of safety.

This review consolidates a body of trial evidence suggesting real benefit for sexual function, strengthening the case that testosterone matters in women's health and not only in men's. At the same time it highlights what is missing: trials long enough to establish safety over years of use, and clarity on effects such as the fall in HDL cholesterol. The overall message is of a promising therapy carrying unresolved questions, rather than a settled treatment with a clean bill of health.

For women whose sex life has suffered after menopause, this is a reason to know that testosterone therapy exists and has randomised trial evidence behind it for sexual function. It is equally a reason to understand the trade-offs: lower HDL cholesterol in some studies, and a long-term safety record that has not yet been established. That combination makes this a topic worth being informed about and discussing, rather than a simple yes or no.