Testosterone therapy in women: Does it boost sex drive?

Does testosterone therapy help increase sex drive in menopausal women? When should this be considered? What are the pros and cons?

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Answer

There is no consensus among doctors about the benefits and risks of testosterone therapy for menopausal women.

Testosterone is one of the hormones that contribute to healthy sexual function in women. But testosterone therapy often isn't recommended to improve a low sex drive because other factors frequently are more important in determining the drive or desire for sexual intimacy in women.

A variety of factors associated with menopause and aging may contribute to changes in sexual desire and function. These include decreased estrogen levels, vaginal dryness, medication side effects, chronic health conditions, or the loss of a spouse or partner.

Testosterone levels decline gradually with age. Natural menopause doesn't lead to lower testosterone levels. However, surgical menopause — which occurs after surgical removal of the ovaries — can lead to a sudden drop in testosterone levels.

Some women experience changes in sexual function after removal of their ovaries or from other causes of low testosterone levels. But many do not. If after removal of the ovaries, a woman experiences a reduced sex drive, depression and fatigue — despite taking estrogen therapy — a doctor may recommend adding low-dose testosterone therapy. Testosterone therapy may also be considered for postmenopausal women taking estrogen who have a decreased sex drive with no other identifiable causes.

If your doctor has evaluated your sexual concerns and believes that they are due to a testosterone deficiency, testosterone therapy may be prescribed in the form of a cream, gel or patch applied to the skin — or sometimes in a pill or injection. However, skin application is preferred.

In general, testosterone therapy is prescribed only for women who have sufficient estrogen levels. Testosterone therapy is generally not recommended for women who are postmenopausal and can't or choose not to take estrogen.

Even when carefully monitored, testosterone therapy can cause side effects. These include acne and excess facial hair growth. Other, less common side effects include lowering of the voice, enlargement of the clitoris, liver problems, and mood or personality changes. Adverse changes in cholesterol levels and liver function are mainly associated with testosterone pills, rather than with skin applications.

There have been no long-term studies of the risks and benefits of testosterone therapy in women. Testosterone therapy should be carefully considered — and monitored, if you choose to go ahead with this treatment.

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