SAT-131 - Role of Testosterone in Postmenopausal Hypoactive Sexual Desire Disorder- A Case Report

INTRODUCTION

Hypoactive sexual desire disorder (HSDD) is characterized by persistent loss of sexual desire with associated psychological distress. It is often underdiagnosed due to limited provider awareness, lack of familiarity with treatment options, and reluctance to discuss sexual concerns. HSDD is associated with reduced quality of life, interpersonal distress, and adverse psychological outcomes, including major depressive disorder. This case highlights the screening strategies and use of testosterone therapy in postmenopausal patients with HSDD.

CASE DESCRIPTION

A 63-year-old postmenopausal woman presented with progressive decline in libido and vaginal dryness since menopause. She reported decreased interest in sexual activity and dyspareunia, leading to cessation of sexual activity, associated with personal distress, relationship strain, and reduced quality of life. She met diagnostic criteria for HSDD based on the Decreased Sexual Desire Screener (DSDS). Management options, including behavioral and couples therapy were discussed, and vaginal lubricants were recommended. Baseline laboratory evaluation showed low normal total testosterone at 16 ng/mL (normal range:10-75ng/mL) and normal sex hormone binding globulin (SHBG), liver function tests, and lipid panel. She was prescribed low dose 1% transdermal testosterone cream after appropriate counseling and informed consent. Follow-up laboratory testing and clinical reassessment were planned for 4–8 weeks. At 4-week follow-up, the patient reported improvement in her symptoms.

DISCUSSION

HSDD is a common yet underrecognized condition, with an estimated prevalence between 8% and 50%. Despite its significant impact, sexual concerns are infrequently addressed in clinical practice. Evaluation includes a comprehensive biopsychosocial assessment with attention to modifiable risk factors and medications. Testosterone therapy is an effective treatment option for postmenopausal women and, although approved in Australia and the United Kingdom, is used off-label in the United States. Randomized trials show improvements in various aspects of sexual function when therapy targets physiologic premenopausal testosterone levels. Adverse effects include acne and increased hair growth, and regular monitoring is essential to avoid supraphysiologic exposure. No serious adverse events have been noted with physiologic testosterone use. Further research is needed for long-term safety data. This case aims to increase awareness of HSDD, emphasize the use of validated screening tools, and highlight the role of testosterone therapy in postmenopausal women with this condition.

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