Testosterone and Women… There has been a lot of media attention to testosterone therapy for women lately. You might ask, but isn’t testosterone the male hormone? Yes, it is, but it is also produced by the ovaries and the adrenal glands in women. In fact, it is the key hormone for sexual arousal and desire in both men and women. Therefore, testosterone levels can greatly impact sexual wellness for couples of all ages, including those 50 and older.
During the cycling years, estrogen far outweighs testosterone in production, potency, and therefore effect. At menopause ovarian estrogen production decreases dramatically, but testosterone production remains about the same. Suddenly testosterone has greater influence. This may be why some women begin to notice dark facial hair after menopause.
Does that mean that if I have a low sex drive (libido) that it must be due to low testosterone? Not necessarily, there are many other things that can affect your sex drive:
- Estrogen levels
- Depression
- Iron deficiency
- Hypothyroidism
- Stress
- Fatigue
- Relationship issues
- Medication side effects, especially SSRI’s, commonly prescribed for anxiety and depression
Is there a blood test for measuring testosterone levels? Yes, there is, but it is not very helpful for a couple of reasons. One, testosterone can fluctuate widely, for example, it is higher in the morning and lower in the evening. Two, the lab results of symptomatic and asymptomatic women are similar.
Therefore testosterone therapy is not based on an established link between symptoms and lab results. As my mentor used to say, it is better to treat the patient than the lab. There is ample evidence that testosterone improves loss of libido in certain women.
An important question is, is it safe? With the low doses appropriate to treat women, no increase in the incidence of common health problems-high cholesterol, diabetes, high blood pressure, and blood clots have been found. Nor is there evidence of the possible side effects of acne, facial hair, male pattern balding, or clitoral enlargement at low doses. Studies of women who have had breast cancer or those with liver disease or heart disease are being conducted and no conclusions are yet available. Testosterone preparations are not yet approved for use by the FDA, but they are approved in Australia and Europe.
Testosterone comes in many forms, creams, gels, patches, and pills. Generally, a treatment that bypasses the GI tract causes fewer side effects. You and your doctor should begin with the method that most appeals to you. Any personal trial should last three months, to really get an idea of effectiveness and side effects.
The take-home message: We physicians have been treating women with testosterone for years, many of whom have had symptom improvement and improved sexual well-being. If you are surgically or naturally menopausal, if you are on estrogen therapy, and if you have decreased sex drive that cannot be attributed to other causes, you are probably a candidate for a trial of therapy. Talk it over with your health provider.
