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Adequate therapeutic management of women with hypoactive sexual desire disorder (HSDD) is a key unmet need and represents an important challenge for sexual medicine professionals. Grounded in the important role of androgens in female sexual function at both the brain and peripheral (genitalia) levels, testosterone therapy has arisen as a treatment option for women experiencing HSDD.1 In this sense, testosterone supplementation has shown superiority to placebo in randomized clinical trials for the treatment of HSDD in postmenopausal women.2,3 Despite the lack of government-approved testosterone formulations for HSDD, therapists are prescribing off-label testosterone products approved for men. The study by Kohn et al4 provides a real-life picture of the treatments with testosterone for women with HSDD. Analyzing clinical records from 33 418 women diagnosed with HSDD revealed that only 850 (2.54%) women with HSDD of all ages received testosterone prescriptions at any time. They confirmed that testosterone therapy was more frequent among postmenopausal and perimenopausal women who, in fact, together with women with premature ovarian insufficiency and early menopause, are the specific populations of women with HSDD candidates for receiving testosterone therapy as per the guidelines from the International Society for the Study of Women’s Sexual Health.5 The trend of testosterone prescriptions is slowly increasing from 2015 in all age groups but with an accentuated increase in perimeopausal women in 2018 and 2019. Although the study gives a clear picture of testosterone prescriptions and provides a context of events that could influence the rate of prescriptions, this represents only one side of the question. I mean that the main conclusion of the study is that further research is needed to adequately manage HSDD in women with either testosterone or another therapeutic strategy. This could be included in the context that the research in sexual function and dysfunction is still lagging far behind in females with respect to males. In my opinion, the study by Kohn et al is interesting for opening more questions than providing certainties. In addition to clinical trials solving uncertainties on efficacy and safety of testosterone therapy for HSDD to provide convincing evidence for regulatory entities, research is needed for understanding additional open questions. Is the mechanism of action of testosterone elucidated at all levels? Is there a specific profile of woman with HSDD indicating a therapeutic response to testosterone supplementation? In this sense, are circulating testosterone levels the only parameter to consider? Could premenopausal women benefit from testosterone therapy? Although the focus on actual testosterone treatment rates does not provide answers to these questions, the article by Kohn et al accurately indicates that the health and well-being of women with HSDD requires the efforts and collaboration of all involved professionals.

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