Remember a few years back when there was a sudden flurry of media attention paid to a libido boosting nasal spray (the one New York magazine called “the first real, honest-to-God, horny-making, body-shaking, equal-opportunity aphrodisiac”)? And then last year the company that was developing the spray had its stock price plummet after the FDA said it had “serious concerns” about side effects. Remember when I said that New York Magazine’s “sex issue” probably wasn’t the best place to get information about sexual pharmacology? Well today I’m offering some preventative warning.

This time it’s a different drug, but same goal, and same method of deliver; the nasal spray. (as an aside, did some pharma marketing whiz stumble across data about boomers romanticizing cocaine? What’s with all these libido boosters you can snort?)

A study published this month in the Annals of Internal Medicine set out to measure how effective testosterone treatment is in improving sexual satisfaction among premenopausal women. The 16 week study took a group of 261 women between the ages of 35 and 46 and administered different amounts of testosterone (low, intermediate, and high doses) to three groups and a placebo to a fourth group. Among the findings, all the women, including those that got the placebo had an increase in self-reported “satisfactory sexual events” but the group that got the intermediate dose of testosterone showed a “significant” increase in satisfactory events (overall the increase represented 0.8 more sexually satisfying events per month).

Just as interesting as the study itself (which as the authors and journal editors point out, is too small to offer any generalizable information, and because of the strong placebo effect raises as many questions as it answers) is an editorial commentary by Rosemary Basson. Basson has been very involved in recent discussions and debates about how best to define sexual dysfunctions experienced by women, and she offers a helpful review of the newest research on testosterone and sexual desire. In her analysis the results of this study are “ambiguous” and using testosterone as therapy to treat female sexual dissatisfaction is “premature”. She reminds us of the lack of long term safety data, the concerns about a link between higher androgen levels and breast cancer and cardiovascular disease, and finally of the importance and efficacy of other types of treatment for sexual dissatisfaction:

I advise primary physicians to assess women’s sexual concerns in detail, then address mental health and relationship issues and any sexual dysfunction in the partner. Then, if necessary, schedule further follow-up to treat the issues by conventional therapy, such as cognitive behavioral therapy, sex therapy, psychotherapy, and mindfulness techniques. The patient should understand the lack of long-term safety data if she is considering investigational testosterone

I hope that journalists who are always wowed by the PR magic that claims testosterone as the hormone of desire will take note of Basson’s commentary, and not just get excited about another dream of desire in a spray bottle.

_Sources:

1. Davis S, Papalia MA, Norman RJ, O’Neill S, Redelman M, Williamson M, et al. “Safety and Efficacy of a Testosterone Metered-dose Transdermal Spray for Treating Decreased Sexual Satisfaction in Premenopausal Women. A Randomized Trial” Annals of Internal Medicine Vol. 148 (2008): 569-577.
2. Basson, R. “Testosterone Supplementation to Improve Women’s Sexual Satisfaction: Complexities and Unknowns” Annals of Internal Medicine Vol. 148 (2008): 620-621.