A case series of androgen use in breast cancer survivors with sexual dysfunction

Introduction. Sexual dysfunction, including problems with vaginal dryness, dyspareunia, decreased libido, and difficulty with orgasm, is a common complaint among female breast cancer survivors. Despite the prevalence of female sexual dysfunction, there is a lack of Food and Drug Administration (FDA)-approved treatment options for hypoactive sexual desire disorder (HSDD) in women. Testosterone therapy may be one option. Aim. This is a case series describing the experience of breast cancer patients who used testosterone to treat sexual dysfunction. Methods. We report on three patients with a history of breast cancer who chose to continue testosterone therapy for improved sexual function despite conflicting reports of efficacy and lack of safety data on testosterone use in breast cancer patients. The patients described here expressed understanding of the risks and adamantly wished to continue testosterone therapy. Main outcome Measures. All patients received a comprehensive sexual medicine evaluation including complete gynecological and psychosexual evaluations. Results. The improved sexual functioning is a quality-of-life parameter for these patients, and the unknown testosterone safety profile is an individually accepted level of risk. As studies emerge reporting beneficial effects of testosterone on libido and sexual function, the use of testosterone-containing therapies can be expected to increase among postmenopausal women. Conclusions. Further studies are needed to investigate the long-term effects of testosterone use in patients with breast cancer or at increased risk for developing breast cancer to definitively address the safety issues.