Low sexual desire, difficulty becoming aroused and lubricating during sex, and increasing difficulty in reaching orgasm are all common complaints of women in mid-life, and all are signs of low testosterone in women. Many people don’t realize that women’s bodies need the “male” hormone testosterone (T) in their system for optimal sexual function, just as do men. But recent studies have provided insight into how testosterone supplementation can be a safe therapy to improve sexual desire, arousal and pleasure for women.
Between 20% to 40% of women express concerns with Female Sexual Dysfunction (FSD). FSD includes a cluster of symptoms including: low desire, decreased sexual arousal, painful intercourse, and changes in ability to orgasm. FSD is most common in older women (over 50 yrs old) but one third of younger women experience a lack of sexual desire that causes them distress.
A recent medical review (Khera, Sex Med Rev 2015) discussed the safety and efficacy of testosterone therapy in treating Female Sexual Dysfunction. Currently, in the US there is no FDA approved testosterone product for women, although these products are available in other countries. At least 4 million T prescriptions are written each year in the US for treating FSD in women and the number is increasing.
Testosterone in the blood stream is important for women’s sexuality because it increases blood flow to the vagina. This blood flow is critical for arousal and engorgement of the clitoris that leads to orgasm. But T levels decrease by over 50% from the time a woman is in her 20s to when she is in her 60s. Also, a woman’s ovaries make over 50% of the T in her body, so women who have had complete hysterectomies and had their ovaries removed, have substantially lower circulating T than women with their ovaries.
Women undergoing surgical removal of their ovaries experience a dramatic andpermanent decrease by 50% in their testosterone production.
Most T in a woman’s body is carried by sex hormone-binding globulin (SHBG), with only 2% of the T in a woman’s body being free in the blood stream and active. High SHBG levels can decrease the available T in a woman making her functionally low T. Many conditions can increase SHBG levels including: liver disease, anti-depressants, seizure medications, aging, pregnancy, oral contraceptives, and estrogen-only hormone replacement.
Signs of Testosterone Deficiency in Women
Although a T deficiency can occur at any time, it is most common during menopause. Symptoms include: decreased muscle mass, increased fat, thinning of hair, fatigue and lack of energy, depression, anxiety and FSD. Unfortunately, it is difficult to measure the very low levels of biologically active T in women, so blood tests are not helpful for diagnosing low T. Active symptoms may be a better guide to when therapy is warranted.
Level 1 evidence (the highest level of certainty) supports that T improves sexual function in menopausal women, both those undergoing natural and surgical menopause. Additionally, a large placebo controlled study (the best kind) found that the rate of sexually satisfying events doubled for menopausal women undergoing T therapy, even without estrogen Hormone Replacement Therapy. Specifically, these studies found significantly greater desire, improvement in arousal, and orgasmic function for women on T therapy. Women normally require about 4 to 8 weeks for the benefit of T therapy to become evident. Small studies have also found a benefit of T in younger, pre-menopausal women, but more data is required in this area.
The most common side effects of T replacement (occurring in about 10% of women) are hair growth (including facial hair) and acne. Usually these are seen in women who may be on too high a dose, or it may take a few months for the woman to become use to the therapy.
Studies to date do not support a link between T therapy and breast or uterine cancer or cardiovascular disease.
T therapy appears to be “safe and effective” in treating Female Sexual Dysfunction in women. However, medical groups remain somewhat conflicted about T therapy in female patients. Those that recommend against T therapy often overlook the increased Quality of Life and Sexual Satisfaction reported for women taking T supplementation, while focusing on perceived risks that have not been demonstrated in the literature.
You can read more about why FDA’s failure to approve drugs, such as T, for women’s sexual dysfunction is a political hot potato and my own journey with T therapy during menopause in my book Slippery When Wet: One Woman’s Journey Through the Mystery of Sex.
– Dr. E http://www.blogher.com/testosterone-hormone-replacement-therapy-female-sexual-dysfunction?wrap=blogher-topics/love-sex/sex&crumb=106916
Contact Boston Testosterone/Core New England Today to discuss our therapies and for more information on having your levels checked.