# Presentation: 405822

## Androgen Therapy for Low Sexual Desire: A Concerned Physician’s View

**James A. Simon, M.D.**
**Clinical Professor**
**George Washington University**
**Washington, DC**
**Medical Director**
**The Women’s Health Research Center**
**Laurel, MD**

## Issues

**Is low sexual desire really a clinical problem for women? **
**Beyond clinical concerns about acne, and hirsutism, does androgen therapy increase a woman’s risk of breast cancer?**
**Personal Perspective**

## Prevalenceof Sexual Dysfunction in Women

- Laumann EO, et al. *JAMA.* 1999;281:537-544.

- *Women aged 18-59 years

**32%**

**28%**

**21%**

**27%**

**Percentage of Women***

**43% of Women Experience Some Form of Sexual Dysfunction**

## Sexual Behavior and Sexual Dysfunctions After Age 40:The Global Study of Sexual Attitudes and Behaviors

**Objective:**** To assess the importance and prevalence of sexual dysfunction among middle aged and older adults around the world**
**Data ****were collected in 29 countries from 27,500 men and women aged 40-80 using questionnaires**
**Sexual dysfunction**** was defined as “frequent and persistent problems**
**	****Sexual dysfunctions**** studied in women were:**
**Lack of sexual interest **
**Lubrication difficulties and pain during intercourse**
**Inability to achieve orgasm**

- From: Nicolosi, Laumann, Glasser, et al. Urology 64: 991-997, 2004

## Sexual Behavior and Sexual Dysfunctions After Age 40:The Global Study of Sexual Attitudes and Behaviors

**Results (women):**
**	****65% of the women had sexual intercourse during the past year**
**The most common sexual dysfunctions found in women were:**
**Lack of sexual interest ****(21%)**
**Lubrication difficulties and pain during intercourse ****(16%)**
**Inability to achieve orgasm ****(16%)**
**Conclusion****: Overall ****39%**** of the women said they were affected by at least one sexual dysfunction**

- From: Nicolosi, Laumann, Glasser, et al. Urology 64: 991-997, 2004

## Breast Cancer Incidence in Postmenopausal Women Using Testosterone in Addition to Usual Hormone Therapy

**Objective****: To determine if testosterone protects women from breast cancer when added to standard hormone therapy**
**Design****: Retrospective, observational trial of 508 postmenopausal women receiving testosterone therapy (average age 56.4; mean follow-up 5.8 years) **
**Outcomes****: Breast cancer incidence with testosterone compared to nonusers and standard hormone therapy users from the literature**

- From: Dimitrakakis, Jones, Liu and Bondy. Menopause: 11: 531-535, 2004

## Breast Cancer Incidence in Postmenopausal Women Using Testosterone in Addition to Usual Hormone Therapy

**Results****: expressed as rate/100,000 women-years**
**On testosterone: 238**
**On testosterone, estrogen/progestin: 293**
**On estrogen/progestin (from WHI): 380**
**On estrogen/progestin (from Million Women Study): 521**
**Never users (from Million Women Study): 283**
**Conclusions****: “...the addition of testosterone to conventional hormone therapy for postmenopausal women does not increase and may indeed reduce the hormone therapy-associated breast cancer risk-thereby returning the incidence to the normal rates observed in the general, untreated population”**

- From: Dimitrakakis, Jones, Liu and Bondy. Menopause: 11: 531-535, 2004

## Summary and Conclusions

**There is a serious need for safe and effective therapies for all aspects of sexual dysfunction in women**
**Low sexual desire is a very common complaint of postmenopausal women affecting more than 20% of women over age 40**
**While hormone therapy appears to increase the risk of  breast cancer, the addition of testosterone does not appear to increase this risk.**