Nappi Rossella E, Albani Francesca, Santamaria Valentina, Tonani Silvia, Martini Ellis, Terreno Erica, Brambilla Emanuela, Polatti Franco
Department of Morphological, Eidological and Clinical Sciences, Research Centre for Reproductive Medicine, University of Pavia, Pavia, Italy.
Menopause Int. 2010 Dec;16(4):162-8. doi: 10.1258/mi.2010.010041.
The present short review underlines the role of testosterone (T) in the motivational and satisfaction components of women's sexuality and critically discusses the strategies to treat hypoactive sexual desire disorder (HSDD), a condition of low desire associated with personal and/or interpersonal difficulties, which is more common in surgical menopausal women. There are multiple ways androgens target the brain regions (hypothalamic, limbic and cortical) involved in sexual function and behaviour. Even though circulating available androgens have been implicated in several domains of sexual response, they seem to be related weakly to symptoms, such as low sexual desire, poor sexual arousal, orgasm and diminished well-being in postmenopausal women. The possibilities of treating low sexual desire/HSDD are multifaceted and should include the combination of pharmacological treatments able to maximize biological signals driving the sexual response, and individualized psychosocial therapies in order to overcome personal and relational difficulties. Transdermal T has been shown to be effective at a dose of 300 µg/day both in surgically and naturally menopausal women replaced with estrogen or not, without any relevant side-effects. However, the decision to treat postmenopausal women with HSDD with T is mainly based on clinical judgement, after informed consent regarding the unknown long-term risks.
本简短综述强调了睾酮（T）在女性性动机和满意度方面的作用，并批判性地讨论了治疗性欲减退障碍（HSDD）的策略。HSDD是一种与个人和/或人际关系问题相关的低性欲状况，在手术绝经女性中更为常见。雄激素有多种方式作用于参与性功能和行为的脑区（下丘脑、边缘系统和皮层）。尽管循环中的可用雄激素与性反应的多个方面有关，但它们与绝经后女性的性欲低下、性唤起不足、性高潮及幸福感降低等症状的关联似乎较弱。治疗低性欲/HSDD的可能性是多方面的，应包括能够最大化驱动性反应的生物信号的药物治疗与个体化心理社会治疗的结合，以克服个人和人际关系方面的困难。经皮睾酮已被证明，无论是否使用雌激素替代治疗，对于手术绝经和自然绝经的女性，每日剂量300μg均有效，且无任何相关副作用。然而，在告知绝经后HSDD女性关于未知长期风险的知情同意后，用睾酮治疗她们的决定主要基于临床判断。
