Can Testosterone Help Women Boost Their Sex Drive?

A few times a year, I have lunch with a group of women I have known since high school. Back then, sitting in the cafeteria, we would talk about our lives in great detail. Now, we meet at places where the food is a lot better.

But the intimate conversations continue, only with a slightly different slant. Instead of classes, crushes and painful period cramps, we are talking about kids, spouses and the uncomfortable symptoms of menopause.

It was at one of these lunches that I first heard about using testosterone for ease of some menopause symptoms. One of the women said her physician had taken testosterone along with her other hormonal treatments. Subsequently, after this conversation, I saw several reports on the news that testosterone use for women is on the rise.

Next Avenue discussed the topic back in 2013. More than a decade later, has anything changed?

When women approach menopause, their bodies start producing less estrogen. The term "hormone replacement therapy" (HRT) is no longer used, and instead, the correct terminology is "hormone therapy" (HT) or "menopause hormone therapy" (MHT). HT can help to decrease many symptoms associated with menopause, including hot flashes, vaginal dryness, brain fog and weight gain.

"Hormone therapy is about increasing a woman's estrogen level," says Stephanie S. Faubion, M.D., director of Mayo Clinic's Women's Center for Women's Health and medical director for the Menopause Society and author of the book "The New Rules of Menopause." "But we aren't trying to replace what the ovaries have lost or bring them to the level they were in pre-menopause"

Basic HT includes estrogen as a pill, skin patch, ring, gel or cream. If a woman still has a uterus, physicians will often also prescribe progesterone or progestin to stop overgrowth of the uterine lining (that estrogen can cause.)

While testosterone is primarily thought of as the male sex hormone, women also produce testosterone. Like estrogen, women produce less testosterone as they get older.

"Testosterone does decrease as women age not because of menopause but due to aging," Faubion explains. "Testosterone therapy has been successful in treating low libido in menopausal women, but there is insufficient evidence to support that it helps with other symptoms such as low energy, improved muscle mass or increased mental clarity."

Decreased sex drive is a commonly reported symptom of women in perimenopause and menopause. Anna Barbieri, M.D., assistant clinical professor in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, explains, "Pre-menopause, 27% of women report a low sex drive compared to over 50% in or post-menopause. This number is even higher if a woman's ovaries have been removed, which can make desire drop like a brick."

While low testosterone can be a cause of low libido, there are also many other reasons. Low libido can stem from physical issues such as vaginal dryness or pain during intercourse, Faubion says, "If sex feels like razor blades, it's not surprising a woman would not be in the mood very often."

There can also be a wide range of non-physical reasons for low libido. Relationship problems, stress, anxiety or side effects from other medications being taken, such as anti-depressants, are just a few causes of lower sexual desire in older women. Cultural factors can also be an issue. "Some women may believe that it is 'natural' for libido to diminish or even disappear with age and that there are no solutions," Barbieri says.

Recently, there has been a lot of attention in the media and from celebrities about menopause and menopause remedies, including testosterone, which has been billed as a "miracle drug" for a wide range of menopause symptoms.

"It's important to get your information from reliable resources," Faubion explains. "And the current research does not support its use beyond treating low libido, and even then, it's not the first option."

Barbieri adds, "There may be women using testosterone and finding that they do have an improved mood or increase in energy. That may be because of testosterone therapy but also because their relationship has improved or the return of sexual desire may make feel more 'like themselves' or it could be completely unrelated — a placebo effect. That is why we need more research in this area."

"Testosterone therapy is not one-size-fits-all," Barbieri explains. "It is important to use testosterone only with a doctor's supervision to get to the right dose." Medical professionals will prescribe testosterone typically in a gel or cream formulation. There are currently no FDA-approved testosterone formulations for women, so typically a male product is used and adjusted for female dosing.

"There are also non-FDA approved pellets on the market, which can be problematic because the dose and absorption may be less predictable and result in overdosing and side effects," Barbieri says.

For patients who are candidates for testosterone therapy, it's best to proceed cautiously and increase the dose as deemed necessary. "Too much testosterone can put women into the male range," Faubion explains. "It can have negative side effects including acne, hair growth in unwanted places, hair loss, enlargement of the clitoris and voice changes, some of which can be permanent."

Patients suffering from low libido should discuss this with their physician. "No one needs to suffer in silence," Barbieri says. "For a long time, we just assumed that it was a normal part of aging for women to lose interest in sex and that there was nothing that could be done about it. But we have had a cultural shift, which has opened up the conversation around what is 'normal,' and reduced taboos around sex lives of older women. Sexuality is complex and multidimensional and fortunately there are ways to increase desire if this is something a woman cares to do."

A good clinician will ask many questions and delve deeper into reasons for low libido, including reviewing medical history, medications and lifestyle circumstances. A physical exam along with blood work is also helpful to determine if low testosterone might be a contributing factor.

"There are several reasons a woman may be experiencing low libido, and testosterone will not address many of them," Faubion says. "However, testosterone therapy can be considered in select women with low sexual desire with appropriate monitoring."

Randi Mazzella is a freelance writer specializing in a wide range of topics from parenting to pop culture to life after 50. She is a mother of three grown children and lives in New Jersey with her husband.  Read more of her work on randimazzella.com. Read More