Clinical audit of testosterone therapy practice patterns for hypoactive sexual desire dysfunction in postmenopausal women

Abstract

Background

This retrospective clinical audit evaluates practice patterns and associative outcomes of testosterone therapy for hypoactive sexual desire dysfunction (HSDD) in postmenopausal women. A clinical audit was conducted on 45 postmenopausal women attending a postmenopausal clinic between July 1, 2024, and December 31, 2024, followed for a 3-month period.

Methods

Data extracted included presenting complaints, HSDD symptom identification, baseline and follow-up testosterone levels, counseling on side effects, and adherence to standard dosing protocols. Simulated data, based on observed audit criteria adherence rates from clinical practice, were utilized to demonstrate analytical methodology. Missing data (35.6%) were handled using complete case analysis after confirming missingness completely at random (MCAR).

Results

Results suggest an association between testosterone therapy and increased testosterone levels from baseline (17.7 ± 4.8 ng/dL) to 3-month follow-up (39.5 ± 7.6 ng/dL) in patients with complete paired data (n = 29) (mean difference: 21.8 ng/dL, 95% CI: [18.2, 25.3], p < 0.001, Cohen’s d: 2.33). Patient compliance rate was 91.1% (95% CI: [79.3%, 96.5%]). Clinical improvement in HSDD symptoms, defined a priori as an increase of ≥ 1.2 points on the Female Sexual Function Index (FSFI) desire domain, was reported in 78% of patients (95% CI: [63.7%, 87.5%]). While the audit criteria for HSDD screening and appropriate prescribing showed high adherence (95.6% and 100% respectively), there were areas for improvement in baseline (68.9%) and follow-up (64.4%) testosterone level measurements.

Conclusion

This clinical audit highlights the associative benefits of testosterone therapy for HSDD and underscores the critical importance of adherence to clinical guidelines for monitoring. Testosterone therapy is associated with increased circulating testosterone levels in postmenopausal women with corresponding clinical symptom improvement. However, given the use of simulated data for analytical demonstration, definitive conclusions regarding treatment effectiveness cannot be drawn. Further prospective studies with larger cohorts and high-quality randomized controlled trials are warranted to confirm these findings.