If a woman’s sexual problems are biological rather than psychological, testosterone therapy may help.
Men may have grabbed the sexual spotlight with Viagra (sildenafil citrate) and erectile dysfunction (ED), but women are equally prone to have concerns about their sex lives. While there may not be a woman’s equivalent to Viagra, if you are concerned about sex, take comfort in knowing that you are not alone. Upwards of 43% of women report some degree of dissatisfaction with their sexual health -- and help is available.
Experts believe that in women, the physical aspect of desire is governed by the male sex hormone, testosterone. Men and women produce both sex hormones, though not in equal amounts. By menopause, a woman produces 50% as much testosterone as she did in her 20s. The loss of testosterone occurs gradually over many years and is unrelated to menopause; however, its impact on desire becomes most evident around menopause, when estrogen production drops off completely. Many experts believe that boosting women’s testosterone levels will improve their libido.
The International Journal of Impotence Research recently reviewed 12 trials comparing testosterone replacement with placebo in postmenopausal women taking estrogen and concluded that testosterone therapy stimulates sexual desire and improves sexual satisfaction. The North American Menopause Society (NAMS) has come to similar conclusions and recommends testosterone to treat hypoactive sexual desire disorder (HSDD).
Currently, though, the only testosterone product approved by the FDA for women is Estratest, a combination of estrogen and methyltestosterone (a type of testosterone that can be taken orally). It is approved only to relieve hot flashes. Still, many doctors prescribe the treatment “off-label” -- outside of its FDA-approved use -- for low desire. Testosterone products approved for men also are sometimes prescribed off-label for women. Less commonly, doctors may use testosterone injections.
The FDA is reviewing the long-term safety of Intrinsa, a testosterone skin patch available in Canada and Europe made specifically for women. There are some safety concerns with long-term testosterone use. A large epidemiological study of postmenopausal women published in the Archives of Internal Medicine reported an association between an increased risk of invasive breast cancer and the use of testosterone and estrogen. NAMS recommends women use testosterone along with estrogen, as it is used in most clinical trials, but that they use it for no more than six months.
Despite these concerns, Leonard DeRogatis, Ph.D., Director of The Center For Sexual Medicine at Sheppard Pratt and a Hopkins faculty member says, “It is highly unlikely that testosterone contributes to breast cancer.” The biggest problem with transdermal (through the skin) versions of testosterone is the potential for facial hair growth and transient acne. In severe instances methyltestosterone can cause liver toxicity, but these effects can be avoided by careful monitoring. “The testosterone patch is probably the most effective delivery system; however, it is not yet available in the United States,” says Dr. DeRogatis.
Although Dr. DeRogatis believes that women will someday benefit more fully from testosterone, he says they should expect to see effective nonhormonal therapies for HSDD in the future: “Some are in the making and development is likely to be pushed along as a result of women beginning to demand more options to improve their sex life.”
