Does testosterone replacement therapy (TRT) affect female orgasm?

From the Guidelines

Testosterone replacement therapy (TRT) can improve female orgasm in women with low testosterone levels, as evidenced by a study published in 2024, which found that intravaginal testosterone cream improved vaginal atrophy and sexual function in postmenopausal survivors of hormone receptor-positive breast cancer 1. When considering TRT for female orgasm, it is essential to note that the treatment should be individualized and monitored by a healthcare provider. The study published in 2024 found that intravaginal testosterone cream was safe and effective in improving vaginal atrophy and sexual function in postmenopausal survivors of hormone receptor-positive breast cancer 1. Some key points to consider when evaluating the use of TRT for female orgasm include:

• The importance of documenting low testosterone levels before initiating treatment
• The need for regular monitoring of potential side effects, such as acne, facial hair growth, and cardiovascular effects
• The individualized nature of the treatment, which may involve different doses and administration methods
• The potential benefits of TRT in improving sexual function, including orgasm intensity and frequency, in women with low testosterone levels. It is also important to note that other treatment options, such as pelvic floor physical therapy, vaginal estrogen, and vaginal androgens, may also be effective in improving female orgasm and sexual function 1.

From the Research

Effects of Testosterone Replacement Therapy on Female Orgasm

• The use of transdermal testosterone (TDT) has been shown to increase the number of orgasms in postmenopausal women with hypoactive sexual desire disorder (HSDD) 2, 3, 4, 5, 6.
• Studies have used various measures to evaluate the effectiveness of TDT, including the Sexual Activity Log (SAL), Profile of Female Sexual Function (PFSF), and Personal Distress Scale (PDS) 2, 3, 4.
• The results of these studies have consistently shown that TDT increases sexual desire, arousal, and orgasm frequency in postmenopausal women with HSDD 3, 4, 5, 6.
• A systematic review and meta-analysis of randomized controlled trials found that testosterone treatment significantly increased orgasm frequency in postmenopausal women, with a standardized mean difference of 0.25 (95% CI 0.18 to 0.32) 6.
• The use of TDT has also been shown to descrease personal distress and increase sexual satisfaction in postmenopausal women with HSDD 2, 3, 4, 5, 6.

Safety and Efficacy of Testosterone Replacement Therapy

• The safety and efficacy of TDT for the treatment of HSDD in postmenopausal women have been established in several studies 2, 3, 4, 5, 6.
• The most common adverse events reported with TDT treatment are application site reactions, acne, and hair growth 3, 4, 6.
• A systematic review and meta-analysis found that TDT was associated with a significantly greater likelihood of reporting acne and hair growth, but no serious adverse events were recorded 6.
• The use of TDT has been shown to be beneficial for postmenopausal women with low sexual desire causing distress, with administration via non-oral routes (e.g., transdermal application) preferred due to a neutral lipid profile 6.