Testosterone and Women’s Sex Drive
In men, testosterone is responsible for the development of masculine characteristics, such as the deepening of the voice, growth of facial hair during puberty, maintenance of sex drive, and production of sperm cells during adulthood. But what most people do not know is that the testosterone production is also important in women. And when women do not produce enough, they may experience declines in their libido, energy, and well-being.
Testosterone Production in Women
While men produce most of their testosterone in the testes, women produce about half in the ovaries and half in the adrenal gland. Once a woman reaches ]]>menopause]]>, the production of all her hormones decreases. Although testosterone production does not fall as sharply as estrogen and progesterone do, it still drops by about half. Women who have had radical ]]>hysterectomies]]> are even more likely to have below-normal testosterone levels, because they no longer have their ovaries.
It is widely known that testosterone affects libido—in both men and women. And testosterone production tends to decline with age. Fluctuations in testosterone levels may also have as much—or more—to do with declining libido as low testosterone levels. For example, women in a study who had fluctuating testosterone levels were more likely to report decreased libido than those who had more stable testosterone levels.
Assessing Testosterone Levels
Testosterone testing is not widely performed in women. However, your doctor may choose to test your testosterone levels to monitor your therapy if you receive testosterone replacement.
Coping With Low Testosterone
If you and your doctor believe that your symptoms are related to low testosterone levels, what options do you have? In some cases, testosterone replacement therapy (TRT) may be used for women. While the Food and Drug Administration (FDA) has not approved TRT for women, many doctors have been prescribing it, along with estrogen therapy, for their postmenopausal patients complaining of low libido. The forms of TRT available for men are not designed for women, since they have much higher testosterone levels.
Does TRP work? A review of 35 trials found that there is not enough evidence as to the effectiveness and safety of TRP in women. Given the mixed results, more studies need to be done.
Light has also been shed recently on testosterone’s safety. In a study published in July 2006 in the Archives of Internal Medicine , researchers found that testosterone may increase the risk of breast cancer in postmenopausal women. Postmenopausal women who take estrogen plus testosterone were found to be at significantly higher risk of developing breast cancer than women who took estrogen only or who had never used hormone therapy. Study participants who used estrogen plus testosterone had an increased risk of developing breast cancer, compared to those who had never used hormone therapy.
Given this concern about safety and lack of proof that is works, TRP may not be the first or best option to improve your libido. Your doctor can help you find out if you have a medical condition or are taking a medicine that is affecting your sex drive. Often, treating the condition or adjusting the medicine can improve your sex life. Your doctor can also refer you to a therapist who may be able to help.
The Endocrine Society
Sexuality Information and Education Council of the United States
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
Female sexual problems. American Association for Marriage and Family Therapy website. Available at: http://www.aamft.org/families/consumer_updates/femalesexualproblems.asp . Accessed November 17, 2003.
Highlights from ASRM 2002. Press release. American Society of Reproductive Medicine website. Available at: http://www.asrm.org/Media/Press/agingd.html . Accessed November 17, 2003.
Longcope C. Adrenal and gonadal androgen secretion in normal females. Clinic Endocrinol Metab . 1986;15:213-228.
Medical tests—testosterone. Henry Ford Health System website. Available at: http://www.henryfordhealth.org/14577.cfm . Accessed November 17, 2003.
Patient’s guide to low testosterone: 2003 edition. Endocrine Society. Medical Library website. Available at: http://www.medem.com/medlb/article_detaillb.cfm?article . Accessed November 6, 2003.
Shifren JL, Braunstein GD, Simon JA, et al. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Engl J Med . 2000;343:682-688.
Somboonporn W, Davis S, Seif MW, et al. Testosterone for peri- and postmenopausal women. ConchraneDatabase of Systematic Reviews . (4):CD004509, 2005.
Tamimi RM, Hankinson SE, Chen WY, et al. Combined estrogen and testosterone use and risk of breast cancer in postmenopausal women. Arch Intern Med . 2006;166:1483-1489.
Testosterone therapy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 2010. Accessed May 3, 2010.
Women and testosterone: An interview with a Mayo Clinic specialist. Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm? . Accessed November 17, 2003.
Last reviewed May 2010 by ]]>Brian Randall, MD]]>
Copyright © 2007 EBSCO Publishing All rights reserved.