Published by the National Women's Health Resource Center
Androgen Therapy
- Loss of Sexual Desire in Women
- Medical Treatment for Sexual Problems
- Questions to Ask
Androgen Therapy
Although they're considered "male" hormones, androgens play important roles in a woman's reproductive cycle and overall health. Produced in your ovaries, adrenal glands and fat cells, androgens like testosterone have more than 200 actions in women.
Most important: They are converted to estrogen. But they also kick-start puberty, stimulate hair growth in the pubic and underarm areas and regular the function of many organs and tissues, including the reproductive tract, bone, kidneys, liver and muscle. Last, but certainly not least, androgens are thought to contribute to a woman's sexual drive and satisfaction. Unlike estrogen, androgen levels don't suddenly drop when you reach natural menopause. Instead, androgen production begins slowly dropping in your twenties. By the time you reach menopause, you're producing about half the amount you were making at puberty. However, your ovaries still continue to product small amounts of androgens after menopause.
Questions to Ask Your Health Care Professional
- Are you up to date on androgen hormone disorders? If not, can you refer me to someone who is?
- Are my symptoms associated with an androgen hormone disorder?
- What other conditions could cause these symptoms?
- Will an androgen abnormality affect my fertility?
- How will you determine my androgen levels? What is too low? Too high?
- I seem to have less interest in sex now that I'm older. What medical steps might help me?
- Does the birth control pill I'm taking have anti-androgen effects?
- What side effects are possible with this medication?
- How long should I take this medication?
Loss of Sexual Desire in Women: The Basics
As women move into middle age, some find they become less interested in sex. This isn't necessarily related to menopause or the menopausal transition, called perimenopause. Indeed, a major women's health study found that other factors, including health, income, psychological factors, the physical and sexual health of a woman's partner and a woman's own lifestyle have a much greater affect on a woman's libido, or sexual desire, than anything related to changing hormone levels.
However, since estrogen is responsible for vaginal lubrication, lower levels may affect mucus membranes like the vagina, making it drier and thinner and interfering with sexual pleasure.
To understand why you might lose interest in sex, it's important to first understand how the female sexual cycle operates. Groundbreaking new research into women's sexuality conducted in the early part of this decade suggests women's sexual desire, particularly for women in long-term relationships, is governed more by thoughts and emotions than by any physical feeling in the genitals (quite different from men). Instead, in women, experiencing pleasure triggers arousal, which subsequently triggers desire. Thus, intimacy - not biology (or hormones) - drives desire, defined as wanting to have sex with someone.
However, hormones, primarily testosterone, are responsible for a woman's sex drive. This is the physical part of sex - the feeling that lets you know that your body, at least, is interested. You can experience desire without drive and drive without desire.
So when do you know if you have a sexual problem? You have a problem if your lack of desire, drive or sexual satisfaction affects your quality of life. If, for instance, you want to make love with your partner but are physically unable. Or if the fact that you don't want to make love with your partner bothers you and affects the quality of your relationship. Or if your lovemaking is unsatisfying. That's when it's time to talk to a health care professional.
Medical Treatments for Sexual Problems
We're still not quite sure whether the reduced androgen levels that occur with aging are responsible for the loss of sexual drive some women experience as they age. However, it's clear that supplemental testosterone therapy improves sexual drive, arousal and orgasm after menopause in some women, particularly those thrust into sudden menopause by the surgical removal of their ovaries. Surgical menopause, as it's called, results in a dramatic drop in androgen and estrogen production. About 50 percent of women who experience surgical menopause report a drop in sexual desire and drive.
Unfortunately, there is no surefire way to determine if androgen levels in women are too low. Commercial laboratories can't accurately detect the small levels of androgens women produce. Instead, if your health care professional thinks you might benefit from androgen therapy - also called testosterone therapy - he or she will likely start you on a very small dose and monitor you carefully.
Unfortunately, there is no U.S. Food and Drug Administration (FDA) - approved form of testosterone for treating sexual disorders in women. However, there are testosterone-containing products - pill, patches, creams and gels - that are approved for use in men and/or women for other indications. Typically, health care professionals prescribe these compounds "off label," a perfectly legal thing to do. And, there's an estrogen/testosterone combination available for women.
This may change in the future. Several companies are trying to develop a testosterone product to treat sexual dysfunction in women who experience premature menopause (defined as menopause before age 40). One testosterone patch product came before the FDA in 2004. It was designed for use in women whose ovaries had been removed. The FDA committee asked for more safety data on the patch, however, and the company withdrew its application to consider further study of the therapy.
There are usually few, if any, side effects from the small amounts of supplemental testosterone used to treat sexual desire disorders in women. One possible side effect with oral testosterone may be reduced levels of "good" cholesterol, or HDL cholesterol. But this isn't seen with testosterone patches, gels or creams. There are also some reports that higher levels of testosterone could lead to acne and hair growth (in places you don't want hair) in women. But if you're taking testosterone, your doctor will monitor you closely for these side effects.
You should also know that there is very little evidence about the affects of testosterone on women who are not also taking supplemental estrogen. This is an issue you should discuss with your health care professional.
Other Reasons for Androgen Therapy
Sexual problems are not the only reason for androgen therapy in women. Women with Turner's Syndrome, a genetic condition in which the ovaries fail to develop, may require supplemental testosterone. Additionally, women in premature menopause may need testosterone therapy not only for sexual reasons but to restore overall well being, including energy and muscle strength.
Finally, testosterone is also an effective treatment for AIDS-related wasting and is being studied as a possible treatment for severe premenstrual syndrome (PMS) and certain autoimmune diseases in women.
Resources
Female Sexual Dysfunction Online
www.femalesexualdysfunctiononline.org
Sexual health information for consumers and clinicians; created by Baylor College of Medicine
National Women's Health Resource Center
1-877-986-9472
"Midlife Health Center" online offers a variety of menopause and midlife health information; Women's Health Update: Premature and Surgical Menopause publication now available.
Nurture Your Nature
Inspiring Sexual Wellness
A joint initiative of the National Women's Health Resource Center and the Association of Reproductive Health Professionals to raise awareness about sexuality as a natural and valued aspect of American women's health. With a special focus on menopausal women, Web site offers a variety of resources and links.
North American Menopause Society
480-442-7550
Leading national organization of menopause specialists providing professional and consumer information
References
Arlt W. "Androgen therapy in women." Eur j Endocrinol. Jan 1, 2006; 154(1): 1-11.
Avis NE, Stellato R, Crawford S, Johannes C, Longcope C. "Is there an association between menopause status and sexual functioning? Menopause." 2000 Sep - Oct; 7(5): 297-309.
Basson R. "The female sexual response: a different model." J Sex Marital Ther. Jan - Mar 2000; 26(1):51-65
The role of testosterone therapy in post-menopausal women: position statement of the North American Menopause Society. Menopause. Sept-Oct 2005; 12(5): 497-s1 1; quiz 649.
Zussman L, Zussman S, Sunley R, Bjornson E. "Sexual response after hysterectomy-oophorectomy: recent studies and reconsideration of psychogenesis." Am J Obstet Gynecol. Aug 1, 1981; 140(7): 725-729.
Henderson D. "FDA Advisers Vote Against Female Sex Drug." Associated Press, Dec 3, 2004.