Testosterone therapy in women with androgen deficiency: Its time has come

Current Opinion in Investigational Drugs

Volumn 11, Issue 10, 2010, Pages 1116-1126

  Guay, A ^a   Traish, A ^a  

^a LAHEY HOSPITAL AND MEDICAL CENTER   (United States)

Author keywords

Androgen treatment; decreased libido; female androgen deficiency; female hypogonadism; female sexual arousal disorder; female sexual dysfsunction; free testosterone; hypoactive sexual desire disorder; testosterone

Indexed keywords

ANDROSTENEDIONE; ESTRADIOL PLUS NORETHISTERONE ACETATE; PLACEBO; PRASTERONE; PRASTERONE SULFATE; TESTOSTERONE; TIBOLONE;

ABSENCE OF SIDE EFFECTS; ACNE; ANDROGEN DEFICIENCY; ANDROGEN THERAPY; CLINICAL FEATURE; DIAGNOSTIC TEST; DRUG EFFECT; EARLY MENOPAUSE; FEMALE; HIRSUTISM; HUMAN; OUTCOME ASSESSMENT; REVIEW; SEXUAL FUNCTION; STEROID METABOLISM; TESTOSTERONE BLOOD LEVEL; TREATMENT DURATION; TREATMENT INDICATION;

ANDROGENS; BREAST NEOPLASMS; CARDIOVASCULAR DISEASES; CLINICAL TRIALS AS TOPIC; DEHYDROEPIANDROSTERONE; EUNUCHISM; FEMALE; HORMONE REPLACEMENT THERAPY; HORMONES; HUMANS; MALE; TESTOSTERONE; TIME FACTORS;

EID: 77957558769     PISSN: 14724472     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (93)

1. Abdallah RT, Simon JA: Testosterone therapy in women: Its role in the management of hypoactive sexual desire disorder. Int J Impot Res (2007) 19(5):458-463.
2. Schwenkhagen A, Studd J: Role of testosterone in the treatment of hypoactive sexual desire disorder. Maturitas (2009) 63(2):152-159.
3. Basson R: Pharmacotherapy for women's sexual dysfunction. Expert Opin Pharmacother (2009) 10(10):1631-1648.
4. Studd J, Schwenkhagen A: The historical response to female sexuality. Maturitas (2009) 63(2):107-111.
5. Jutel A: Framing disease: The example of female hypoactive sexual desire disorder. Soc Sci Med (2010) 70(7):1084-1090.
6. Traish AM, Feeley RJ, Guay AT: Testosterone therapy in women with gynecological and sexual disorders: A triumph of clinical endocrinology from 1938 to 2008. J Sex Med (2009) 6(2):334-351.
7. Garcia-Banigan DC, Guay AT: Female androgen insufficiency syndrome. In: Male and female sexual dysfunction. Seftel AD (Ed), Mosby, New York, NY, USA (2004):267-274.
8. Legrain S, Massien C, Lahlou N, Roger M, Debuire B, Diquet B, Chatellier G, Azizi M, Faucounau V, Porchet H, Forette F et al: Dehydroepiandrosterone replacement administration: Pharmacokinetic and pharmacodynamic studies in healthy elderly subjects. J Clin Endocrinol Metab (2000) 85(9):3208-3217.
9. Labrie F, Luu-The V, Lin SX, Simard J, Labrie C, El-Alfy M, Pelletier G, Bélanger A: Intracrinology: Role of the family of 17 β- hydroxysteroid dehydrogenases in human physiology and disease. J Mol Endocrinol (2000) 25(1):1-16.
10. Genazzani AD, Stomati M, Bernardi F, Pieri M, Rovati L, Genazzani AR: Long-term low-dose dehydroepiandrosterone oral supplementation in early and late postmenopausal women modulates endocrine parameters and synthesis of neuroactive steroids. Fert Steril (2003) 80(6):1495-1501.
11. Stomati M, Rubino S, Spinetti A, Parrini D, Luisi S, Casarosa E, Petraglia F, Genazzani AR: Endocrine, neuroendocrine and behavioral effects of oral dehydroepiandrosterone sulfate supplementation in postmenopausal women. Gynecol Endocrinol (1999) 13(1):15-25.
12. i2,3. J Biol Chem (2002) 277(24):21379-21388.
13. Liu D, Dillon JS: Dehydroepiandrosterone stimulates nitric oxide release in vascular endothelial cells: Evidence for a cell surface receptor. Steroids (2004) 69(4):279-289.
14. Williams MR, Dawood T, Ling S, Dai A, Lew R, Myles K, Funder JW, Sudhir K, Komesaroff PA: Dehydroepiandrosterone increases endothelial cell proliferation in vitro and improves endothelial function in vivo by mechanisms independent of androgen and estrogen receptors. J Clin Endocrinol Metab (2004) 89(9):4708-4715.
15. Zapata E, Ventura JL, De la Cruz K, Rodriguez E, Damián P, Massó F, Montaño LF, López-Marure R: Dehydroepiandrosterone inhibits the proliferation of human umbilical vein endothelial cells by enhancing the expression of p53 and p21, restricting the phosphorylation of retinoblastoma protein, and is androgen- and estrogen-receptor independent. FEBS J (2005) 272(6):1343-1353.
16. Simoncini T, Mannella P, Fornari L, Varone G, Caruso A, Genazzani AR: Dehydroepiandrosterone modulates endothelial nitric oxide synthesis via direct genomic and nongenomic mechanisms. Endocrinology (2003) 144(8):3449-3455.
17. Lee SY, Myung SC, Lee MY, Kim TH, Kim SC, Kim KD, Park SH, Kim WY: The effects of dehydroepiandrosterone (DHEA)/DHEA-sulfate (DHEAS) on the contraction responses of the clitoral cavernous smooth muscle from female rabbits. J Sex Med (2009) 6(10):2653-2660.
18. [No authors listed]: Androgen insufficiency in women. Proceedings of the Princeton Conference. Princeton, New Jersey. July 29, 2001. Fertil Steril (2002) 77(Supp 4):S1-S99.
19. Davis SR: When to suspect androgen deficiency other than at menopause. Fertil Steril (2002) 77(Supp 4):S68-S71.
20. Traish AM, Kim N, Min K, Munarriz R, Goldstein I: Role of androgens in female genital arousal: Receptor expression, structure, and function. Fertil Steril (2002) 77(Supp 4):S11-S18.
21. Davis SR, McCloud P, Strauss BJ, Burger H: Testosterone enhances estradiol's effects on postmenopausal bone density and sexuality. Maturitas (1995) 21(3):227-236.
22. Vanbillemont G, Bogaert V, De Bacquer D, Lapauw B, Goemaere S, Toye K, Van Steen K, Taes Y, Kaufman JM: Polymorphisms of the SHBG gene contribute to the interindividual variation of sex steroid hormone blood levels in young, middle-aged and elderly men. Clin Endocrinol (2009) 70(2):303-310.
23. Guay A, Jacobson J, Munarriz R, Traish A, Talakoub L, Quirk F, Goldstein I, Spark R: Serum androgen levels in healthy premenopausal women with and without sexual dysfunction: Part B: Reduced serum androgen levels in healthy premenopausal women with complaints of sexual dysfunction. Int J Impot Res (2004) 16(2):121-129. (Pubitemid 38579456)
24. Guay AT, Jacobson J: Decreased free testosterone and dehydroepiandrosterone-sulfate (DHEA-S) levels in women with decreased libido. J Sex Marital Ther (2002) 28(Suppl 1): 129-142.
25. Davison SL, Bell R, Donath S, Montalto JG, Davis SR: Androgen levels in adult females: Changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab (2005) 90(7):3847-3853.
26. Wierman ME, Basson R, Davis SR, Khosla S, Miller KK, Rosner W, Santoro N: Androgen therapy in women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab (2006) 91(10):3697-3710.
27. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM; Task Force, Endocrine Society: Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab (2010) 95(6):2536-2559.
28. Traish A, Guay AT, Spark RF, Testosterone Therapy in Women Study Group: Are the Endocrine Society's Clinical Practice Guidelines on Androgen Therapy in Women misguided? A commentary. J Sex Med (2007) 4(5):1223-1234; discussion 1234-1235.
29. Braunstein GD: The Endocrine Society Clinical Practice Guideline and The North American Menopause Society position statement on androgen therapy in women: Another one of Yogi's forks. J Clin Endocrinol Metab (2007) 92(11): 4091-4093.
30. North American Menopause Society: The role of testosterone therapy in postmenopausal women: Position statement of The North American Menopause Society. Menopause (2005) 12(5):496-511.
31. Simon JA, Nachtigall L, Casson P, Lucas J, Schofield V, Melson C: The safety and tolerability of the transdermal testosterone patch (TTP) for up to 4 years in surgically menopausal women on estrogen therapy. Gynecol Endocrinol: in press.
32. Nijland EA, Weijmar Schultz WC, Nathorst-Boös J, Helmond FA, Van Lunsen RH, Palacios S, Norman RJ, Mulder RJ, Davis SR, LISA study investigators: Tibolone and transdermal E2/NETA for the treatment of female sexual dysfunction in naturally menopausal women: Results of a randomized active-controlled trial. J Sex Med (2008) 5(3):646-656.
33. Baulieu EE, Thomas G, Legrain S, Lahlou N, Roger M, Debuire B, Faucounau V, Girard L, Hervy MP, Latour F, Leaud MC et al: Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: Contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci USA (2000) 97(8):4279-4284.
34. Panjari M, Bell RJ, Jane F, Wolfe R, Adams J, Morrow C, Davis SR: A randomized trial of oral DHEA treatment for sexual function, well-being, and menopausal symptoms in postmenopausal women with low libido. J Sex Med (2009) 6(9):2579-2590.
35. Shifren JL, Braunstein GD, Simon JA, Casson PR, Buster JE, Redmond GP, Burki RE, Ginsburg ES, Rosen RC, Leiblum SR, Caramelli KE et al: Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Engl J Med (2002) 343(10):682-688.
36. Kingsberg S: Testosterone treatment for hypoactive sexual desire disorder in postmenopausal women. J Sex Med (2007) 4(Suppl 3):227-234.
37. Shufelt CL, Braunstein GD: Safety of testosterone in women. Maturitas (2009) 63(1):63-66.
38. Braunstein G: Safety of testosterone treatment in postmenopausal women. Fertil Steril (2007) 88(1):1-17.
39. Wang C, Cunningham G, Dobs A, Iranamesh A, Matsumoto AM, Snyder PJ, Weber T, Berman N, Hull L, Swerdloff RS: Long-term testosterone gel (androgel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab (2004) 89:2085-2098.
40. Panjari M, Bell RJ, Jane F, Adams J, Morrow C, Davis SR: The safety of 52 weeks of oral DHEA therapy for postmenopausal women. Maturitas (2009) 63(3):240-245.
41. Morales AJ, Haubrich RH, Hwang JY, Asakura H, Yen SS: The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol (1998) 49(4): 421-432.
42. Shaw LJ, Bairey Merz CN, Azziz R, Stanczyk FZ, Sopko G, Braunstein GD, Kelsey SF, Kip KE, Cooper-Dehoff RM, Johnson BD, Vaccarino V et al: Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: Results from the National Institutes of Health - National Heart, Lung, and Blood Institute sponsored Women's Ischemia Syndrome Evaluation. J Clin Endocrinol Metab (2008) 93(4):1276-1284.
43. Patel SM, Ratcliffe SJ, Reilly MP, Weinstein R, Bhasin S, Blackman MR, Cauley JA, Sutton-Tyrrell K, Robbins J, Fried LP, Cappola AR: Higher serum testosterone concentration in older women is associated with insulin resistance, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab (2009) 94(12):4776-4784.
44. Manalakou P, Angelopoulou R, Bakoyiannis C, Bastounis E: The effects of endogenous and exogenous androgens on cardiovascular disease risk factors and progression. Reprod Biol Endocrinoll (2009) 7:44.
45. Brand JS, van der Schouw YT: Testosterone, SHBG and cardiovascular health in postmenopausal women. Int J Impot Res (2010) 22(2):91-104.
46. Laughlin GA, Goodell V, Barrett-Connor E: Extremes of endogenous testosterone are associated with increased risk of incident coronary events in older women. J Clin Endocrinol Metab (2010) 95(2):740-747.
47. Sowers MR, Jannausch M, Randolph JF, McConnell D, Little R, Lasley B, Pasternak R, Sutton-Tyrrell K, Matthews KA: Androgens are associated with hemostatic and inflammatory factors among women at the mid-life. J Clin Endocrinol Metab (2005) 90(11):6064-6071.
48. Basson R, Wierman ME, van Lankveld J, Brotto L: Summary of the recommendations on sexual dysfunction in women. J Sex Med (2010) 7 (1 Pt 2):314-326.
49. Basson R: Testosterone supplementation to improve women's sexual satisfaction: Complexities and unknowns. Ann Intern Med (2008) 148(8):620-621.
50. Raynaud JP, Pujos-Gautraud M, Pasqualini JR: Testosterone, other androgens and breast cancer. In: Breast cancer: Prognosis, treatment, and prevention. Pasqualini JP (Ed), Informa Healthcare, New York, NY, USA (2008):181-200.
51. Schover LR: Androgen therapy for loss of desire in women: Is the benefit worth the breast cancer risk? Fertil Steril (2008) 90(1):129-140.
52. Traish AM, Fetten K, Miner M, Hansen M, Guay A: Testosterone and risk of breast cancer: Appraisal of existing evidence. Horm Mol Biol Clin Invest (2010) 2(1):177-190.
53. Fogle RH, Stanczyk FZ, Zhang X, Paulson RJ: Ovarian androgen production in postmenopausal women. J Clin Endocrinol Metab (2007) 92(8):3040-3043. (Pubitemid 47236368)
54. Davis SR, Moreau M, Kroll R, Bouchard C, Panay N, Gass M, Braunstein GD, Hirschberg AL, Rodenberg C, Pack S, Koch H et al: Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med (2008) 359(19):2005-2017.
55. Panay N, Al-Azzawi F, Bouchard C, Davis SR, Eden J, Lodhi I, Rees M, Rodenberg CA, Rymer J, Schwenkhagen A, Sturdee DW: Testosterone treatment of HSDD in naturally menopausal women: The ADORE study. Climacteric (2010) 13(2):121-131.
56. Arlt W: Androgen therapy in women. Eur J Endocrinol (2006) 154(1):1-11.
57. Panjari M, Davis SR: DHEA therapy for women: Effect on sexual function and wellbeing. Hum Reprod Update (2007) 13(3):239-248.
58. Alkatib AA, Cosma M, Elamin MB, Erickson D, Swiglo BA, Erwin PJ, Montori VM: A systematic review and meta-analysis of randomized placebo-controlled trials of DHEA treatment effects on quality of life in women with adrenal insufficiency. J Clin Endocrinol Metab (2009) 94(10):3676-3681.
59. Hunt PJ, Gurnell EM, Huppert FA, Richards C, Prevost AT, Wass JA, Herbert J, Chatterjee VK: Improvement in mood and fatigue after dehydroepiandrosterone replacement in Addison's disease in a randomized, double blind trial. J Clin Endocrinol Metab (2000) 85(12):4650-4656.
60. Løvås K, Gebre-Medhin G, Trovik TS, Fougner KJ, Uhlving S, Nedrebø BG, Myking OL, Kämpe O, Husebye ES: Replacement of dehydroepiandrosterone in adrenal failure: No benefit for subjective health status and sexuality in a 9-month, randomized, parallel group clinical trial. J Clin Endocrinol Metab (2003) 88(3):1112-1118.
61. Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, Girard G, Baron M, Ayotte N, Moreau M, Dubé R et al: Serum steroid levels during 12-week intravaginal dehydroepiandrosterone administration. Menopause (2009) 16(5):897-906.
62. Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, Girard G, Baron M, Ayotte N, Moreau M, Dubé R et al: Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Menopause (2009) 16(5):923-931.
63. Perelman MA: The sexual tipping point: A mind/body model for sexual medicine. J Sex Med (2009) 6(3):629-632.
64. Sherwin BB, Gelfand MM: Sex steroids and affect in the surgical menopause: A double-blind, cross-over study. Psychoneuroendocrinology (1985) 10(3):325-335.
65. Myers LS, Dixen J, Morrissette D, Carmichael M, Davidson JM: Effects of estrogen, androgen, and progestin on sexual psychophysiology and behavior in postmenopausal women. J Clin Endocrinol Metab (1990) 70(4):1124-1131.
66. Watts NB, Notelovitz M, Timmons MC, Addison WA, Wiita B, Downey LJ: Comparison of oral estrogens and estrogens plus androgen on bone mineral density, menopausal symptoms, and lipid-lipoprotein profiles in surgical menopause. Obstet Gynecol (1995) 85(4):529-537.
67. Raisz LG, Wiita B, Artis A, Bowen A, Schwartz S, Trahiotis M, Shoukri K, Smith J: Comparison of the effects of estrogen alone and estrogen plus androgen on biochemical markers of bone formation and resorption in postmenopausal women. J Clin Endocrinol Metab (1996) 81(1):37-43.
68. Miller K, Corcoran C, Armstrong C, Caramelli K, Anderson E, Cotton D, Basgoz N, Hirschhorn L, Tuomala R, Schoenfeld D, Daugherty C et al: Transdermal testosterone administration in women with acquired immunodefciency syndrome wasting: A pilot study. J Clin Endocrinol Metab (1998) 83(8): 2717-2725.
69. Shifren JL, Braunstein GD, Simon JA, Casson PR, Buster JE, Redmond GP, Burki RE, Ginsburg ES, Rosen RC, Leiblum SR, Caramelli KE et al: Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Engl J Med (2000) 343(10):682-688.
70. Dobs AS, Nguyen T, Pace C, Roberts CP: Differential effects of oral estrogen versus oral estrogen-androgen replacement therapy on body composition in postmenopausal women. J Clin Endocrinol Metab (2002) 87(4):1509-1516.
71. Goldstat R, Briganti E, Tran J, Wolfe R, Davis SR: Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Menopause (2003) 10(5): 390-398.
72. Lobo RA, Rosen RC, Yang HM, Block B, Van Der Hoop RG: Comparative effects of oral esterified estrogens with and without methyltestosterone on endocrine profiles and dimensions of sexual function in postmenopausal women with hypoactive sexual desire. Fertil Steril (2003) 79(6): 1341-1352.
73. Warnock JK, Swanson SG, Borel RW, Zipfel LM, Brennan JJ, ESTRATEST Clinical Study Group: Combined esterified estrogens and methyltestosterone versus esterified estrogens alone in the treatment of loss of sexual interest in surgically menopausal women. Menopause (2005) 12(4):374-384.
74. Braunstein GD, Sundwall DA, Katz M, Shifren JL, Buster JE, Simon JA, Bachman G, Aguirre OA, Lucas JD, Rodenberg C, Buch A et al: Safety and efficacy of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: A randomized, placebo-controlled trial. Arch Intern Med (2005) 165(14):1582-1589.
75. Buster JE, Kingsberg SA, Aguirre O, Brown C, Breaux JG, Buch A, Rodenberg CA, Wekselman K, Casson P: Testosterone patch for low sexual desire in surgically menopausal women: A randomized trial. Obstet Gynecol (2005) 105(5 Pt 1):944-952.
76. Simon J, Braunstein G, Nachtigall L, Utian W, Katz M, Miller S, Waldbaum A, Bouchard C, Derzko C, Buch A, Rodenberg C et al: Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder. J Clin Endocrinol Metab (2005) 90(9): 5226-5233.
77. Shifren JL, Davis SR, Moreau M, Waldbaum A, Bouchard C, DeRogatis L, Derzko C, Bearnson P, Kakos N, O'Neill S, Levine S et al: Testosterone patch for the treatment of hypoactive sexual desire disorder in naturally menopausal women: Results from the INTIMATE NM1 Study. Menopause (2006) 13(5): 770-779.
78. Davis SR, Goldstat R, Papalia MA, Shah S, Kulkarni J, Donath S, Bell RJ: Effects of aromatase inhibition on sexual function and well-being in postmenopausal women treated with testosterone: A randomized, placebo-controlled trial. Menopause (2006) 13(1):37-45.
79. Shah S, Bell RJ, Savage G, Goldstat R, Papalia MA, Kulkarni J, Donath S, Davis SR: Testosterone aromatization and cognition in women: A randomized, placebo-controlled trial. Menopause (2006) 13(4):600-608.
80. Davis SR, van der Mooren MJ, van Lunsen RH, Lopes P, Ribot C, Rees M, Moufarege A, Rodenberg C, Buch A, Purdie DW: Efficacy and safety of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: A randomized, placebo-controlled trial. Menopause (2006) 13(3):387-396.
81. El-Hage G, Eden JA, Manga RZ: A double-blind, randomized, placebo-controlled trial of the effect of testosterone cream on the sexual motivation of menopausal hysterectomized women with hypoactive sexual desire disorder. Climacteric (2007) 10(4):335-343.
82. Davis S, Papalia MA, Norman RJ, O'Neill S, Redelman M, Williamson M, Stuckey BG, Wlodarczyk J, Gard'ner K, Humberstone A: Safety and efficacy of a testosterone metered-dose transdermal spray for treating decreased sexual satisfaction in premenopausal women: A randomized trial. Ann Intern Med (2008) 148(8):569-577.
83. van der Made F, Bloemers J, Yassem WE, Kleiverda G, Everaerd W, van Ham D, Olivier B, Koppeschaar H, Tuiten A: The influence of testosterone combined with a PDE5-inhibitor on cognitive, affective, and physiological sexual functioning in women suffering from sexual dysfunction. (2009) 6(3):777-790.
84. Nathorst-Boos J, Hammar M: Effect on sexual life - A comparison between tibolone and a continuous estradiol-norethisterone acetate regimen. Maturitas (1997) 26(1):15-20.
85. Castelo-Branco C, Vicente JJ, Figueras F, Sanjuan A, Martínez de Osaba MJ, Casals E, Pons F, Balasch J, Vanrell JA: Comparative effects of estrogens plus androgens and tibolone on bone, lipid pattern and sexuality in postmenopausal women. Maturitas (2000) 34(2):161-168.
86. Morales AJ, Nolan JJ, Nelson JC, Yen SS: Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab (1994) 78(6):1360-1367.
87. Arlt W, Callies F, van Vlijmen JC, Koehler I, Reincke M, Bidlingmaier M, Huebler D, Oettel M, Ernst M, Schulte HM, Allolio B: Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med (1999) 341(14): 1013-1020.
88. Johannsson G, Burman P, Wirén L, Engström BE, Nilsson AG, Ottosson M, Jonsson B, Bengtsson BA, Karlsson FA: Low dose dehydroepiandrosterone affects behavior in hypopituitary androgen-deficient women: A placebo-controlled trial. J Clin Endocrinol Metab (2002) 87(5):2046-2052.
89. Hackbert L, Heiman JR: Acute dehydroepiandrosterone (DHEA) effects on sexual arousal in postmenopausal women. J Womens Health Gend Based Med (2002) 11(2):155-162.
90. Meston CM, Heiman JR: Acute dehydroepiandrosterone effects on sexual arousal in premenopausal women. J Sex Marital Ther (2002) 28(1):53-60.
91. Nair KS, Rizza RA, O'Brien P, Dhatariya K, Short KR, Nehra A, Vittone JL, Klee GG, Basu A, Basu R, Cobelli C et al: DHEA in elderly women and DHEA or testosterone in elderly men. N Engl J Med (2006) 355(16):1647-1659.
92. Brooke AM, Kalingag LA, Miraki-Moud F, Camacho-Hübner C, Maher KT, Walker DM, Hinson JP, Monson JP: Dehydroepiandrosterone improves psychological well-being in male and female hypopituitary patients on maintenance growth hormone replacement. J Clin Endocrinol Metab (2006) 91(10):3773-3779. (Pubitemid 44536842)
93. Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, Girard G, Baron M, Ayotte N, Moreau M, Dubé R et al: Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Menopause (2009) 16(5):923-931.