Effects of testosterone treatment on clitoral haemodynamics in women with sexual dysfunction

Abstract

Purpose To explore the effects of 6-month systemic testosterone (T) administration on clitoral color Doppler ultrasound (CDU) parameters in women with female sexual dysfunction (FSD). Methods 81 women with FSD were retrospectively recruited. Data on CDU parameters at baseline and after 6 months with four different treatments were available and thus further longitudinally analyzed: local non-hormonal moisturizers (NH group), n = 37; transdermal 2% T gel 300 mcg/day (T group), n = 23; local estrogens (E group), n = 12; combined therapy (T + E group), n = 9. Patients underwent physical, laboratory, and genital CDU examinations at both visits and completed different validated questionnaires, including the Female Sexual Function Index (FSFI). Results At 6-month visit, T therapy significantly increased clitoral artery peak systolic velocity (PSV) when compared to both NH (p < 0.0001) and E (p < 0.0001) groups. A similar increase was found in the T + E group (p = 0.039 vs. E). In addition, T treatment was associated with significantly higher FSFI desire, pain, arousal, lubrication, orgasm, and total scores at 6-month visit vs. baseline. Similar findings were observed in the T + E group. No significant differences in the variations of total and high-density lipoprotein-cholesterol, triglycerides, fasting glycemia, insulin and glycated hemoglobin levels were found among the four groups. No adverse events were observed. Conclusion In women complaining for FSD, systemic T administration, either alone or combined with local estrogens, was associated with a positive effect on clitoral blood flow and a clinical improvement in sexual function, showing a good safety profile. Trial registration number NCT04336891; date of registration: April 7, 2020.

Understanding human aging and the fundamental cell signaling link in age-related diseases: the middle-aging hypovascularity hypoxia hypothesis

“…The estrogen replacement therapy has been shown to reduce oxidative stress ( Bellanti et al, 2013 ; Unfer et al, 2015 ; Borrás et al, 2021 ), reduce oxidative stress/inflammation ( Vural et al, 2006 ; Georgiadou and Sbarouni, 2009 ; Jee et al, 2021 ; Estrada-Cruz et al, 2022 ), and improve hemodynamics ( Redberg et al, 2000 ; Light et al, 2001 ; Deschênes et al, 2010 ). Similarly, testosterone replacement therapy can reduce oxidative stress ( Mancini et al, 2008 ; Popp Marin et al, 2010 ; Mendell and MacLusky, 2019 ; Koukoulis et al, 2022 ) and inflammation ( Bianchi, 2019 ; Mohamad et al, 2019 ; Rastrelli et al, 2019 ) and improve hemodynamics ( Efesoy et al, 2018 ; König et al, 2019 ; Cipriani et al, 2021 ). This indicates that sex hormones can reduce hypoxia-induced oxidative stress and inflammation during the critical window of cellular regeneration, rejuvenation, and timing period through physoxia–NO-mediated hemodynamic oxygenation.…”

(050) Low Prolactin Level Identifies Hypoactive Sexual Desire Disorder Women With a Reduced Inhibition Profile

“…This finding could be considered in contradiction with the known estrogenic-dependency of the PRL system in women. However, the unique and special hormonal regulation of the vagina has been recently recognized by demonstrating that the human distal vagina is robustly regulated not only by estrogens but also androgens [40][41][42].…”

Female Sexual Dysfunctions: A Clinical Perspective on HSDD, FAD, PGAD, and FOD

“…Clitoral artery Doppler ultrasound has been proposed as a noninvasive and objective approach to measuring genital blood flow and is easier to use in clinical settings compared to VPP [81,82]. However, this technique has not been fully validated, and the most reproducible hemodynamic parameters (peak systolic velocity, resistance index, pulsatility index, and volume flow) and their normative values have yet to be established.…”