Transdermal Testosterone For Menopause-Related Hyposexual Desire Disorder: Current Guidelines And Provider Perceptions, Knowledge, And Practice

Hypoactive sexual desire or low libido in women are collectively referred to as hypoactive sexual desire disorder (HSDD). HSDD is estimated to occur in 10% to 15% of adult women. HSDD is likely the most common female sexual dysfunction (FSD) in menopausal women. The hallmark of the diagnosis is personal distress and interpersonal difficulties resulting from low sex drive. Most women will not seek help for this problem. Studies have suggested that primary care providers and gynecologic healthcare providers report not feeling qualified to treat patients with sexual dysfunction, especially HSDD. Testosterone, specifically transdermal testosterone, has been suggested to play an integral part in the treatment of HSDD in menopause. It is proven to increase the frequency of satisfying sexual activity, sexual desire, and orgasmic response, and to decrease personal distress. Testosterone has a demonstrated a safety history and medication tolerance when prescribed for this purpose. In spite of its proven efficacy in relation to HSDD, the Food and Drug Administration (FDA) has not approved testosterone for this purpose, though its use for HSDD is currently suggested by the Endocrine Society in their Clinical Practice Guidelines (CPGs). The primary purpose of this study was to assess Vermont primary care providers\u27 and gynecologic healthcare providers\u27 perceptions, knowledge, and practices regarding treatment of HSDD in naturally induced menopause with a focus on transdermal testosterone. After respondent inclusion criteria and demographic information about the respondents was collected, the study asked questions and tested knowledge about topics regarding menopause and sexuality, evaluation of FSD, and treatment of low libido and diminished sexual desire with a focus on testosterone. The study was a descriptive cross-sectional online survey that was completed electronically on a secure server through the University of Vermont. The conclusions were that providers believe sexuality and sexual satisfaction are quality of life indicators and perceived that maintaining sexual function is important to naturally occurring menopausal women. The majority of providers would prescribe a pharmaceutical treatment for menopausal women seeking to maintain their sexual function, enhance sexual satisfaction, and/or treat symptoms of HSDD as long as there were no contraindications. However, testosterone, a proven treatment for women with complaints of low libido and/or diminished sexual desire, was reportedly underutilized. This may be related to inconsistent screening for FSD in menopause at each comprehensive visit and lack of provider knowledge about testosterone (including safety and efficacy) impacting confidence to prescribe testosterone for this purpose. Further, providers were divided on whether low libido and/or diminished sexual desire in naturally occurring menopause is a medical condition or disorder or a natural part of aging. It is unclear how the aforementioned divisions impact evaluation and treatment