Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy.
Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, Viale Pieraccini 6, 50139, Florence, Italy.
Int J Impot Res. 2020 Nov;33(7):703-709. doi: 10.1038/s41443-021-00409-8. Epub 2021 Feb 8.
Hypoactive sexual desire disorder (HSDD) represents a common condition among transgender women. However, to date no specific guidelines for the management of HSDD in transgender persons are available. The aim of the present narrative Review is to evaluate evidence-based treatment for HSDD and to suggest treatment options for HSDD in transgender women. Clinically relevant publications on the management of HSDD (from 1985 to 2020) were searched in PubMed and Medline databases, using the following terms: "sexual desire", "sexual health", "HSDD", "transgender", "gender-affirming treatment", "sexual therapy", "testosterone treatment", "Central nervous system-active medications", and variants. Since sexual desire could be affected by several factors, a comprehensive assessment of HSDD- exploring biological, psychological, and social domains- is recommended, in order to identify possible predisposing, precipitating and maintaining factors. Among treatment options, transgender women may benefit of different sex therapy strategies and/or central nervous system-active medications-such as flibanserin, bremelanotide, bupropion and buspirone-and transdermal testosterone, bearing in mind that this option could be poorly accepted by patients due to the risk of virilizing effects. The lack of data regarding the efficacy of HSDD treatment options in transgender women emphasize the need for literature to focus more on this topic in the future.
性欲减退障碍（HSDD）在跨性别女性中较为常见。然而，目前尚无针对跨性别者 HSDD 管理的具体指南。本综述旨在评估 HSDD 的循证治疗方法，并为跨性别女性的 HSDD 提出治疗选择。在 PubMed 和 Medline 数据库中，使用以下术语搜索了关于 HSDD 管理的临床相关出版物（1985 年至 2020 年）：“性欲”、“性健康”、“HSDD”、“跨性别”、“性别肯定治疗”、“性治疗”、“睾酮治疗”、“中枢神经系统活性药物”及其变体。由于性欲可能受到多种因素的影响，因此建议对 HSDD 进行全面评估——探索生物、心理和社会领域——以确定可能的诱发、促成和维持因素。在治疗选择方面，跨性别女性可能受益于不同的性治疗策略和/或中枢神经系统活性药物，如氟班色林、布雷美尔肽、安非他酮和丁螺环酮以及透皮睾酮，但需要注意的是，由于存在男性化作用的风险，该选择可能不太被患者接受。关于 HSDD 治疗选择在跨性别女性中的疗效的数据缺乏，强调未来文献需要更多地关注这一主题。
