Testosterone, of course, is the hormone that makes guys hairy, muscular, and sexual. But testosterone isn’t only for guys. Women produce it, too, but at much lower levels, and for us, the effects are less linear and more subtle: More testosterone doesn’t necessarily mean more libido. Yet, in many studies, a little touch of testosterone has been strongly linked to a better sex life for women.
So, what’s the big deal about testosterone, anyway? What’s its role in women’s sexuality, and what are the pros and cons of testosterone therapy for women?
First, a refresher: The most common cause of pain with intercourse for the peri-menopausal and menopausal woman is vaginal dryness that comes from the absence of estrogen—in medical terms, vaginal atrophy. The solutions are to restore vaginal estrogen (available by prescription) or restore moisture with regular use of non-hormonal, over the counter options, like Yes or Lubrigyn.
So while estrogen is primary, we also produce testosterone—mainly in our ovaries, and only at about one-tenth the level as in men. Testosterone levels peak in our 20s and early 30s and steadily decline until, surprise!, we’ve lost about 80 percent of our testosterone-producing power after menopause. Women whose ovaries are removed are also cast immediately into “surgically induced menopause.” While we may still be sexual creatures, we’re no longer procreative creatures, so the hormonal stream is reduced to a trickle.
Enter testosterone therapy. Testosterone may be one rabbit in the bag of tricks that addresses the single biggest sexual complaint in women: lack of interest. Testosterone has been called the “hormone of desire” for women. “Women need estrogen for lubrication and comfort during sex. But they need testosterone to feel desire in the first place,” according to author and “Today” show correspondent Judith Reichman in a 2005 “Washington Post” article. In many studies over the years, replacing testosterone has been linked to greater sexual desire, more intense orgasm, and improved sexual performance in women. There’s evidence that it might also improve muscle tone and increase energy levels and mental acuity.
Yet, it’s still only available “off-label,” meaning that there’s no pharmaceutical brand approved by the Food and Drug Administration (FDA). Testosterone can be prescribed by using the male FDA-approved products, at significantly lesser dosing regimens, or by compounding at pharmacies. Testosterone, in natural or synthetic form, is available in long-lasting injections, pellets, patches, and transdermal creams or gels. Oral testosterone or testosterone pills are not recommended because they are metabolized by the liver and the possible changes that result from that.
Testosterone therapy remains controversial. Unlike in men, there’s no direct relationship between libido and blood testosterone levels in women. A woman can have a good sex drive with low testosterone or no interest in sex with high testosterone levels. Additionally, appropriate levels of testosterone for women have been hard to establish since we produce so little of it. Measuring testosterone levels in women is difficult, because of the very low levels and other factors that affect the circulating testosterone. The use of testosterone in women is usually well-tolerated but side effects may include acne and unwanted hair growth. The phase III clinical trials for testosterone use in women appear as though testosterone use in women will be safe, but finalization of these studies and FDA approval are still pending.
Before beginning testosterone therapy, it’s important to address other causes of loss of libido, such as depression, medications, painful intercourse, lack of emotional intimacy, or chronic stress. But, if lack of interest in sex or the inability to experience orgasm continues to be a problem for you or in your relationship, testosterone therapy might be something to explore with your health care provider.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.