In 1984, an implant of estradiol 40 mg and testosterone 100 mg was used in a small pilot study for 6 months in 17 postmenopausal women with decreased libido while taking oral estrogen. The testosterone implant demonstrated an improvement from baseline on self-reported libido and enjoyment of sex. At baseline, 94% of women reported absent or reduced libido compared with 43% of women 3 months after testosterone implantation (p<0.01). All women reported absent or reduced enjoyment of sex at baseline compared with 29% of women after 3 months (p<0.01). The effects returned to baseline levels 4 months after implantation. A placebo effect could not be ruled out due to the lack of a control group, but a follow-up study was published in 1987. This small 6-month study of 20 postmenopausal women with decreased libido while taking estrogen evaluated the effect of an estradiol 40 mg–testosterone 50-mg implant compared with estrogen alone and repeated the results of the pilot study with a significant effect of testosterone on self-reported libido and enjoyment of sex. Sexual symptoms were rated by using a visual analog scale from 0–100. Across both trials, one woman reported hirsutism and weight gain, but no other significant adverse events were reported.
A follow-up study published in 1987 evaluated the impact of an estrogen 8.5 mg–testosterone 150 mg combination (22 women) versus estrogen 10 mg (11) and placebo (11) in women who had been receiving hormones once/month since their hysterectomy and oophorectomy 4 years earlier. Women who received the combination with testosterone reported significantly more sexual desire, arousal, fantasies, and coitus and orgasm on the DMRS than women who received estrogen alone or placebo. The largest increase in coitus and orgasm was reported within the first 2 weeks of the estrogen-testosterone injection and decreased the following 2 weeks before the next injection. This suggests that the physical acts of sex may correlate with testosterone levels.
In 1995, an evaluation of a testosterone 50 mg– estradiol 50 mg implant (17 women) versus an estradiol 50 mg implant alone (16 women) every 3 months for 2 years in postmenopausal women was reported. Women who received the combination treatment with testosterone reported increased orgasm (p<0.035), sexual satisfaction (p<0.03), and sexual activity on the SRS compared with women who received estrogen alone, demonstrating long-term effects for testosterone on sexual desire and function.
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