Testosterone and Women’s Sex Drive
In men, testosterone is responsible for the development of masculine characteristics, such as the deepening of the voice, growth of facial hair during puberty, maintenance of sex drive, and production of sperm cells during adulthood. But what most people don’t know is that the testosterone production is also important in women. And when women don’t produce enough, they may experience declines in their libido, energy, and well-being.
Testosterone Production in Women
While men produce most of their testosterone in the testes, women produce about half in the ovaries and half in the adrenal gland. Once a woman reaches menopause, the production of all her hormones decreases. Although testosterone production does not fall as sharply as estrogen and progesterone do, it still drops by about half. Women who have had radical hysterectomies are even more likely to have below-normal testosterone levels, because they no longer have their ovaries.
It is widely known that testosterone affects libido—in both men and women. And testosterone production tends to decline with age. But new research is suggesting that fluctuations in testosterone levels may have as much—or more—to do with declining libido as low testosterone levels. At the 2002 Annual Meeting of the American Society for Reproductive Medicine, researchers from the University of Pennsylvania presented findings from a study on testosterone and female libido. The women in this study (women in their 30s and 40s) who reported decreased sexual desire had average testosterone levels similar to women with sustained sexual desire. However, the women whose testosterone levels fluctuated were 2-3 times more likely to report decreased libido than those with more stable testosterone levels.
Assessing Testosterone Levels
Testosterone testing is not widely performed in women. Currently, available laboratory tests do not accurately measure testosterone at the levels typically found in women and no specific level has been clearly linked to low libido. However, your doctor may choose to test your testosterone levels to monitor your therapy if you receive testosterone replacement.
Coping With Low Testosterone
If you and your doctor believe that your symptoms are related to low testosterone levels, what options do you have? The use of testosterone replacement therapy (TRT) has become increasingly common in men who suffer from reduced testosterone levels. TRT in testosterone-deficient men has many benefits, including increased sexual interest, restored erectile function, improved mood, and increased lean muscle mass and bone density. But is TRT an option for women?
While the Food and Drug Administration (FDA) has not approved TRT for women, many doctors have been prescribing it, along with estrogen therapy, for their postmenopausal patients complaining of low libido. The forms of TRT available for men are not designed for women, since they have much higher testosterone levels. Doctors need to lower the dose when using these products in their female patients.
Transdermal patches and topical creams, where the testosterone is absorbed through the skin, are preferable over the pill form. A study published in the New England Journal of Medicine in 2000 investigated the effects of an experimental testosterone patch in women who had undergone a hysterectomy and oopherectomy (removal of uterus and ovaries). The researchers found that the patch improved the women’s sexual function and psychological well-being significantly, compared with a placebo patch. And in an analysis of 23 separate studies conducted in 2005, researchers concluded that adding testosterone to estrogen therapy has a beneficial effect on sexual function in postmenopausal women.
Light has also been shed recently on testosterone’s safety. In a study published in July 2006 in the Archives of Internal Medicine, researchers found that testosterone may increase the risk of breast cancer in postmenopausal women. Postmenopausal women who take estrogen plus testosterone were found to be at significantly higher risk of developing breast cancer than women who took estrogen only or who had never used hormone therapy. Study participants who used estrogen plus testosterone had an increased risk of developing breast cancer, compared to those who had never used hormone therapy.
Given this concern about safety, testosterone replacement is not necessarily the first or best option to improve your libido. Your physician can help you find out if you have a medical condition or are taking a medication that is affecting your sex drive. Often, treating the condition or adjusting the medication can improve your sex life. Your physician can also refer you to a therapist who may be able to help.
The American College of Obstetricians and Gynecologists
The Endocrine Society
Sexuality Information and Education Council of the United States
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
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Last reviewed May 2008 by Ganson Purcell Jr., MD, FACOG, FACPE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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