Most people associate menopause with hot flashes. Fair enough, but millions of women going through this change of life complain of a drop in sex drive. Is there any way to restore libido after menopause? One woman found that testosterone cream worked wonders.
Testosterone Cream to Restore Libido:
Q. I had a total hysterectomy 21 years ago. Needless to say, my libido was adversely affected. A year ago, I found a wonderful doctor who prescribed estrogen, progesterone and transdermal testosterone. What a remarkable difference! My desire returned in a big way.
The downside is that my husband isn’t as supercharged as I am. As a result, I’ve cut back on the number of times per week that I apply the testosterone cream. I have not noticed any serious side effects from using testosterone. If I use too much, I might get a small pimple on my face. Why isn’t this treatment more widely used?
The Story on Testosterone Cream:
A. You are right that testosterone can be helpful for reduced sexual desire. While many people think of it as a “male” hormone, women also make this hormone and it has an impact on sexual functioning in women as well as men. A recent review concluded “placebo-controlled trials show an improvement in sexual function with low-dose testosterone therapy in select postmenopausal women with HSDD” [hypoactive sexual desire disorder, aka low libido] (Journal of Women’s Health, online Nov. 5, 2019). The authors point out, however, that most studies are fairly short term and don’t tell whether testosterone supplementation would make women more susceptible to heart disease or breast cancer.
The Pros and Cons of Testosterone:
You asked why more doctors don’t prescribe this treatment. One explanation may be that the FDA has not approved oral or topical testosterone for women. Although doctors can prescribe medications “off label,” many prefer not to do so. They may worry about possible side effects.
In addition, some scientists point out that testosterone cream is most effective in combination with estrogen (Hormones and Behavior, Feb. 2016). As you described, this is the regimen your doctor prescribed.
A different review of placebo-controlled trials found evidence that “testosterone therapy improves sexual function in postmenopausal women” (Clinical Endocrinology, March 2019). However, no one knows if testosterone cream or pills are safe for women over the long term.
Endocrinologists around the world have endorsed the use of testosterone therapy for postmenopausal women only at doses that resemble normal testosterone levels in premenopausal women (Journal of Clinical Endocrinology and Metabolism, Oct. 1, 2019). At “doses that approximate physiological testosterone concentrations for premenopausal women,” postmenopausal women might experience acne or even some facial hair growth. These experts think that other side effects such as baldness, deepening of the voice or clitoral enlargement are unlikely at these doses.