If you are a menopausal woman, chances are pretty good that your sex drive has slowed down since your “roaring twenties and thirties”.
Some of you will go so far as to say that you have no interest in sex whatsoever. There is a really good physiological reason for this decrease in interest. When we hit our forties and beyond, our ovaries start their journey toward menopause. That means that we are getting closer to the end of our ovarian production of both estrogen and testosterone. These hormones play a critical role in our sexual health and wellness. Their decline is a normal part of aging, but it can have a profound physical and emotional impact on some women, while for others this inevitable change barely registers a blip on the radar. And if you’re one of these women? I’ll touch back with you later.
DECREASING LIBIDO AND TESTOSTERONE
As it turns out, midlife women, and that includes me, are faced with so many other reasons for a decrease in libido. Sometimes I feel like I am preaching to the choir, but none of us are particularly interested in sex when we are otherwise involved in juggling careers, households, children, aging parents, and spouses or partners who do not help us out enough. I often joke that we are all married to the same man. I say that because, as a gynecologist, I talk with a lot of women. And they all have the exact same complaints about how much they do to maintain the household and care for kids while their partners do not do enough. Then we have a good laugh about the fact that women are great at multitasking and, frankly, we’re just better at getting everything done correctly the first time. How many of us have given our partners one simple task only to review the result and re-do it anyway? Of course, I acknowledge that there are always exceptions to my theory that we are all married to the same man. I just don’t think there are many!
So that brings me to the topic at hand, which is testosterone. We women make plenty of testosterone from our ovaries, starting at puberty and lasting a few years beyond our final menstrual period. Testosterone has several duties, including improving our sense of well-being and energy, maintaining bone health and, of course, assisting estrogen in the pursuit of sexual health and normal functioning. However, for most menopausal women, testosterone does not turn out to be the answer to the low libido question. In fact, women with normal testosterone levels may complain of a decrease in sexual interest and, in contrast, those with low testosterone levels may have no problems at all. I want you to keep that in mind the next time you insist on having your testosterone levels checked. The blood testosterone level really does not correlate in any way with your libido.
CAN TESTOSTERONE HELP MY LIBIDO?
That leads to the next important question. Testosterone preparations are available in compounding pharmacies, and there is even a testosterone and estrogen combined tablet available in your neighborhood drug store. So, you may be thinking “Why not try it out and see if it helps? What’s the harm?” and you wouldn’t be alone. Many women swear that testosterone is the answer to all their libido issues.
As it turns out, there is a good reason why the FDA has not approved testosterone replacement therapy for women. The scientific studies conducted thus far do not show that testosterone replacement works any better than a placebo. There is also concern that the use of testosterone in midlife women carries an unnecessary risk for male pattern hair growth, acne, deepening voice changes, abnormal liver function, and worsening cholesterol. It may even put women at future risk for heart disease and breast cancer.
The only FDA approved use of testosterone therapy in midlife women is for the diagnosis of hypoactive sexual desire disorder (HSDD). Most of us will not have this disorder, so most of us will not benefit from additional testosterone after menopause.
Therefore, the answer to whether you should try testosterone for your low desire question is… probably not. But I would definitely recommend that you seek an expert in the field to explore all of your options.
And finally, for all of you who have a reduced libido and don’t find yourselves bothered by this? There is absolutely nothing wrong with that. If it isn’t bothering you, it doesn’t bother me!
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