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Testosterone Gel for Female Libido: A Complete Study
Testosterone is not approved by the U.S. Food and Drug Administration (FDA) for
treating sexual problems in women. At this time, there is no testosterone pill,
patch, or cream approved for women in the U.S. Those made for men have too high
a dose for women. But your doctor may prescribe testosterone in a compounded
formula, which is a medicine made just for you by a pharmacist.
Testosterone is known as a "male" hormone, or androgen. It also is made in small
amounts by a woman's adrenal glands and ovaries. A woman's testosterone is
highest around age 20 and slowly declines with age.1
In men, testosterone is linked to male physical traits and sex drive. In women,
testosterone may be linked to sex drive. But for women, interest in sex is much
more complicated than just testosterone levels. Testosterone therapy raises
testosterone levels in the body. But testosterone is only FDA-approved for use
in men.
Methyltestosterone probably does not work in the body and the brain like natural
testosterone does. It does not directly raise a woman's testosterone levels. And
it cannot be measured in the blood like natural testosterone.
Methyltestosterone. This hormone product is sometimes also prescribed to
menopausal women for improving sexual desire and response.
Testosterone is an experimental treatment used to raise a woman's sexual
interest, arousal, and satisfaction. Women with low androgen levels who might
benefit from low-dose testosterone therapy include those who:
Have had their ovaries removed (oophorectomy). This causes a sudden drop in
testosterone, which may reduce sex drive and satisfaction. Have a low sex drive
that does not seem to be caused by a medicine, nor by relationship or
stress-related problems. Have an adrenal system problem or an underactive
pituitary gland (hypopituitarism).
Low libido refers to a woman�s lack of desire for sex and is the most common
sexual problem reported by women. Other common difficulties include problems
with arousal and orgasm.
Sexual well-being is a complex area of women�s health. Low libido always has
more than one cause and it is important to determine whether it is lifelong or
recently acquired. In any one woman, low libido may be linked to relationship
issues, psychological or hormonal changes and even side-effects of medicine.
Hormones are rarely the only factor involved and other factors need to be
addressed.
Women often say that menopause makes them feel more self-conscious about their
bodies, particularly during sex. Other changes may be occurring in a woman�s
life, such as a partner�s midlife issues, teenagers in the house or leaving home
and parents dying or requiring care. Many women find that these additional
stresses mean that the last thing on their mind is sex. For many women,
decreased libido is not seen as a problem in their life. So it only needs to be
addressed when it causes personal concern/distress.
The drop in oestrogen at menopause commonly results in vaginal changes and a
reduction in vaginal secretions may make intercourse uncomfortable or even
painful. Management of this with a vaginal oestrogen preparation or a
non-hormonal vaginal moisturizer can make a significant difference. Menopausal
symptoms which result in sleep disturbance and fatigue will also impact on a
woman�s libido. In such circumstances oestrogen therapy can improve libido in
some women.
In addition to producing oestrogen, the ovaries also produce testosterone. Blood
testosterone levels start to fall when women are in their mid twenties so that
by the time most women are in their forties their levels are half of what they
were in their younger years. For many women this has little effect; however,
this decline may be associated with lowered sexual interest in some women.
Surgical removal of both ovaries causes approximately a 50% reduction in the
level of the hormone testosterone, which may be associated with significant
deterioration of sexual desire, particularly in younger women. These women tend
to have more severe symptoms than the women who experience natural menopause.
Treatment Options for Low Libido
-
 Find a doctor who is interested and experienced in treating this aspect
of your health.
-
Address general health issues, particularly factors that commonly cause
fatigue such as iron deficiency and abnormal thyroid function
-
Address lifestyle issues and ways of reducing stress in your life
-
Consider stresses and tensions in your relationship and possibly
relationship counselling.
-
Any depression or anxiety may need to be dealt with first.
-
Some drugs, especially anti-depressants, can impair sexual
responsiveness. Discuss this with your doctor.
-
Hormone Replacement Therapy (HRT) or tibolone: Tibolone may be more
effective in treating low libido than conventional HRT (see other AMS
pamphlets).
-
Sometimes a major factor is dryness in the vagina causing pain on
intercourse which can be helped by either vaginal oestrogen or HRT
-
Some forms of oral oestrogen such as HRT tablets or the oral
contraceptive pill can reduce a woman�s own testosterone level so a trial
off the pill or changing to a non-oral HRT should be considered if low
libido is a problem.
-
A trial of testosterone therapy can be appropriate for some women.
Testosterone Therapy
Testosterone has been used to treat low libido for several decades but only
recently have clinical trials assessed its usefulness and safety in women. One
of the major difficulties when researching testosterone in women is the
inaccuracy of current hormone blood tests, in addition to the limited knowledge
of what the normal levels are in women of different ages. Of note, testosterone
levels are not necessarily related to low libido but a blood level should be
done prior to starting any testosterone therapy so that women with normal to
high levels are not inappropriately treated.
Testosterone may improve libido, arousal and sexual satisfaction, mood and
energy in some women.
Low libido may improve with oestrogen therapy alone but in some cases
testosterone may also be helpful, especially in women who have had their ovaries
removed.
Oral oestrogen may interfere with the effect of testosterone therapy. Hence the
best effect of testosterone is seen in women using non oral oestrogen such as
patches or gels.
What we don�t know
Which women might benefit from testosterone treatment is not known. Whether
testosterone treatment might cause harm: there are few long-term studies
evaluating the risk of conditions such as heart disease and breast cancer is
also not known.
Although testosterone preparations are available from doctors in Australia, the
government drug regulator, the TGA, has not approved it for the specific use of
treating low libido in women.
Low dose preparations, which have been shown to be safe in the short term can be
used. Unlike ordinary HRT, where blood tests are not normally used to monitor
hormone levels, it is important to have blood tests before starting testosterone
therapy and regularly while using it. If testosterone is used there is often no
effect until 4 to 8 weeks. If there is no benefit after 6 months then therapy
should be stopped. In general about 60% of women report a benefit.
Forms of testosterone
1% testosterone cream.
 There is an approved 1% testosterone cream for women available in Western
Australia. It is applied daily to the skin, and sometimes reduced or increased,
depending on side effects and blood levels. (Although a 2% strength is
available, it is for use in men and when used by women results in testosterone
levels approaching the male range and thus it should not be used by women).
Implants.
These have been a mainstay of therapy for many years for hormone replacement in
men, and occasionally in women. As this treatment approach has now been
superseded with the availability of transdermal testosterone creams and gels,
the testosterone implants are no longer available.
Patches.
These have been approved in Europe for women who have had their ovaries removed
but are not available in Australia other than in a clinical trial.
Side effects of testosterone
Clinical studies show that if used in low doses for short periods of time,
testosterone is well tolerated. The most commonly reported side effects are mild
acne and increased hair growth. Less common side effects at low doses are weight
gain and fluid retention. Serious side effects (rare at low doses) are clitoral
enlargement and voice deepening and these can be permanent. We do not know the
long term effects of testosterone. We do know that oral testosterone lowers HDL
(good) cholesterol whereas testosterone via the skin (cream or patch) does not
have this effect.
Women who are being treated for hormone related acne, excess body hair or
balding (androgenic alopecia) should not use testosterone. Testosterone is not
effective for women who have very high levels of a protein in their blood that
binds testosterone (sex hormone binding globulin or SHBG). Women who have
extremely low levels of this protein (SHBG) are at considerably increased risk
of having side effects of testosterone.
Testosterone should not be used by women who have been diagnosed with a hormone
dependent cancer, such as breast cancer. Professional singers should also not
use testosterone due to the rare but irreversible effect on the voice.
The Debate About Testosterone Supplements for Women
Although it�s common for men to take testosterone to treat low libido, the U.S.
Food and Drug Administration hasn�t approved testosterone replacement therapy
for women. Some doctors do prescribe it for women as an off-label use, Bradley
says. Women are given a fraction of the dose that men are prescribed, and
therapy can involve oral testosterone supplements, a gel or cream, or a patch
applied to the skin. Because giving it to women is controversial, some
pharmacies won�t even sell testosterone to women, Bradley says.
In general, research has shown that testosterone supplements don�t seem to give
women the boost in libido that doctors expected to see. As a result, experts
have doubted whether testosterone is doing what they think it should do, Bradley
says. And because women�s sex drive is affected by so many things, including
lifestyle factors such as relationship problems and stress, it can be difficult
to measure
Also, testosterone has side effects. Acne and hair growth on the upper lip and
chest are the most common; changes in your voice, weight gain, and
male-patterned baldness are all known side effects of the hormone, Bradley says.
The biggest concern is testosterone�s long-term safety in women. Taking the
hormone can raise the risk of developing high cholesterol. Also, testosterone is
converted into estrogen in the body, and there�s concern that increased estrogen
exposure could raise breast cancer risk. �It�s not something to be taken
lightly,� Bradley says.
In one study of 814 women with low sexual desire who used a testosterone patch
or a placebo for 24 weeks, researchers found that at a certain dose the hormone
did help improve sex drive. However, four of the women taking testosterone
developed breast cancer. Researchers don�t know if the hormone caused the cancer
or if it was a coincidence.
If you have low libido, testosterone may help, but it�s important to weigh the
benefits with the risks. In the meantime, Bradley advocates working on other
ways to naturally increase your sex drive, from having healthy eating habits to
turning off your Blackberry and focusing on your partner.
Research shows that the hormone testosterone does impact sex drive � as well as
remedy other sexual problems � in certain women with sexual dysfunction. But the
long-term safety of testosterone therapy for women is unknown. For this reason,
some doctors are hesitant to recommend it. Testosterone therapy usually is
prescribed only for women who have sufficient estrogen levels.
Testosterone therapy might be appropriate if:
 You have reduced sex drive, depression and fatigue after surgically induced
menopause, and estrogen therapy hasn't relieved your symptoms
You are postmenopausal, taking estrogen therapy and have a decreased sex drive
with no other identifiable causes
Long-term safety data on testosterone therapy for postmenopausal women who have
a history of breast or uterine cancer or those who have cardiovascular or liver
disease is lacking and being studied.
Testosterone therapy comes in many forms, such as creams, gels, patches or
pills. The method of administration and dose relate to safety risks, so it's
important to discuss pros and cons with your doctor.
Testosterone preparations are not approved by the Food and Drug Administration
for use in women. So if testosterone is prescribed, it's for off-label use.
Although testosterone contributes to healthy sexual function in women, many
other factors also play a role in postmenopausal sexual dysfunction. These
factors include decreased estrogen levels, vaginal dryness, medication side
effects, chronic health conditions, loss of a spouse or partner, lack of
emotional intimacy, conflict, stress, or mood concerns.
Dated 25 March 2014
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