HSDD in Menopausal Women: Dermatology Meets Hormone Therapy

A review in the Journal of the American Academy of Dermatology, Volume 95, Issue 5, set for publication in November 2026, tackles a question most dermatologists rarely ask at the bedside: what happens to the skin when menopausal women receive antiandrogen or testosterone therapy for hypoactive sexual desire disorder (HSDD)?

Melissa M. Mauskar and Shoshana Marmon authored the piece. Both names will be familiar to readers who follow vulvar dermatology and sexual-health crossover work. Their subject sits squarely at a growing clinical intersection, where hormone-based treatments prescribed for HSDD carry cutaneous consequences that land in the dermatology clinic, not the gynecology suite.

Why does this matter now?

HSDD — persistently low or absent sexual desire causing distress — is a recognized diagnosis in menopausal women, and testosterone therapy has become an increasingly common off-label answer to it in that population. Antiandrogen therapy, meanwhile, runs in the opposite direction pharmacologically. Both drug classes touch the androgen pathway, and the androgen pathway touches the skin through sebaceous glands, hair follicles, and vulvovaginal epithelium.

That's the clinical tension the review addresses. Prescribers managing sexual function and dermatologists managing skin and hair share the same patients, often without sharing information. A review like this one works as a bridge: it tells the dermatologist what to expect, what to monitor, and what to ask.

What does this change for dermatologists?

For practitioners, the practical shift is anticipatory. A menopausal patient on testosterone for HSDD may present with androgen-driven complaints the dermatologist has to connect back to the prescription: acne, hirsutism, seborrhea, or scalp hair thinning. A patient on antiandrogens may present with the mirror image — scalp hair improvement, reduced sebum, or, in some contexts, mucosal and skin-barrier effects tied to reduced androgen signaling.

The review's appearance in JAAD itself signals the editorial judgment that this belongs in dermatology's mainstream literature rather than at the specialty's margins. Skin signs of systemic hormone therapy are not incidental; they're part of the therapeutic profile.

Menopause compounds the picture independently. Declining estrogen already thins the epidermis, slows wound healing, and produces vulvovaginal atrophy. Layering androgen-modulating therapy on top of that baseline changes what the exam shows and how confidently a clinician can attribute a given finding to one hormone or another.

Why the crossover question is worth asking

Dermatologists already manage isotretinoin and spironolactone — drugs with well-understood androgen connections. What's newer is the patient arriving on hormone therapy for sexual dysfunction who never mentions it, because she doesn't see it as skin-relevant. A thorough hormone history in menopausal patients presenting with new acne, alopecia, or hirsutism is the obvious clinical takeaway.

The reverse direction matters too. Dermatologists prescribing antiandrogens for acne or hirsutism in menopausal women should understand the potential interaction with any concurrent HSDD-directed testosterone therapy — the two can, pharmacologically, work against each other.

What to watch for

The full review publishes in November 2026. Dermatologists who treat menopausal patients — which is to say, most dermatologists — will want to read the authors' specific guidance on monitoring cutaneous adverse effects, counseling points, and where the evidence base remains thin. Expect this piece to feed into conversations about integrated menopause care, where dermatology claims a seat alongside gynecology and endocrinology.