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Testosterone Enhances Libido and Improves Female Sexuality

The FDA has approved two drugs to improve women's sexual desire. Trouble is, they have unpleasant side effects. Research shows testosterone enhances libido.

How well does testosterone work to increase women’s sex drive? Many people assume that androgens like testosterone are purely male hormones. Wrong! Women actually make more androgen than estrogen (Fertility and Sterility, April, 2002). Studies have shown that testosterone enhances libido in men who suffer from low levels of this hormone (Sexual Medicine Reviews, July 24, 2019). 

Testosterone Enhances Libido in Women Too

A new meta-analysis of 36 randomized controlled trials involving more than 8,000 postmenopausal women reports that testosterone treatment led to better sexual relations (Lancet Diabetes & Endocrinology, July 25, 2019). Women who took testosterone instead of placebo or estrogen and or progestogen reported improved:

  • Sexual desire
  • Arousal
  • Orgasm
  • Satisfactory sexual event frequency
  • Responsiveness
  • Pleasure
  • Self Image

The authors conclude:

“Testosterone is effective for postmenopausal women with low sexual desire causing distress, with administration via non-oral routes (eg, transdermal application) preferred because of a neutral lipid profile.”

Why Transdermal Testosterone Is Preferred:

Oral testosterone formulations increased LDL cholesterol and lowered beneficial HDL. Topical testosterone in the form of transdermal patches, gels or creams did not have this effect. Some women did complain about acne and modest weight gain.

How Dangerous Is Testosterone?

The authors of the most recent research report:

“No serious adverse event was more frequent with testosterone compared with placebo or a comparator. Specifically, testosterone was not associated with more frequent reporting of cardiovascular events (eg, acute myocardial infarction, stroke, deep vein thrombosis, or cardiovascular deaths.”

“Our systematic review and meta-analysis indicates that current testosterone use was not associated with an increase in serious adverse events, including adverse endometrial and breast effects.”

Reviewing the Evidence that Testosterone Enhances Libido

An accompanying editorial in Lancet Diabetes & Endocrinology (July 25, 2019) concludes that topical testosterone is a reasonable treatment for postmenopausal women with low libido.

The author points out that:

“These findings confirm those of a previous systematic review and meta-analysis which showed short-term efficacy—in terms of improvement of sexual function and the safety of transdermal testosterone—in naturally and surgically menopausal women affected by hypoactive sexual desire disorder and taking or not taking oestrogen–progestin hormone therapy.”

“Finally, short-term use of testosterone does not modify either the breast or the endometrium, but data are insufficient to assess long-term oncological risks.”

The editorial calls for the development of formulations specifically designed for women and long-term studies on safety.

People’s Pharmacy Perspective:

The Food and Drug Administration has approved two drugs for treating low libido. One is flibanserin (Addyi). It’s not all that effective. According to our calculations, this drug led to one more “sexually satisfying event” each month compared to placebo. Side effects include nausea, drowsiness, dizziness, low blood pressure and fainting. Not surprisingly, Addyi has not been a big blockbuster success.

The second drug was just approved by the FDA. It is bremelanotide (Vyleesi). It is administered with an auto-injector. Nausea is a serious complication. As many as 405 of patients reported this side effects. You can read more about the adverse reactions associated with Vyleesi at this link.

Testosterone and other androgens impact the body in numerous ways. These natural hormones have a substantial impact on sexual desire and satisfaction. The problem is that there are currently no female formulations of testosterone on the market. There are male formulations, but they generally have a much higher dose than is recommended for women. And the FDA has not approved testosterone in any dose for women.

We agree with the woman who wrote the editorial in Lancet Diabetes & Endocrinology (July 25, 2019). There is a desperate need for well-controlled, long-term clinical trials using topical testosterone in safe doses. Physicians who currently prescribe topical testosterone off label must rely on compounding pharmacies to create such products.

For example, a decade ago Dr. Rosemary Basson, MD, at the Centre for Sexual Medicine in Vancouver, British Columbia offered this observation (Therapeutic Advances in Endocrinology and Metabolism, Aug. 2010):

“Although clinicians sometimes prescribe topical testosterone to be used sparingly on the vulva in an attempt to restore lost sexual sensitivity of tissues comprising and overlying the clitoris, this practice has not been scientifically studied.”

As far as we can tell, there is still a paucity of research on topical application of testosterone to the outer genital area. What is the lowest effective dose? That will no doubt vary from individual to individual. If topical testosterone enhances libido, can it be used intermittently to lower total systemic absorption and reduce the risk of side effects? It would be nice if researchers made an attempt to answer these questions.

Reports from Readers:

Jayel shared this story:

“I found a wonderful physician who put me on a low-dose testosterone (in addition to balancing out my estrogen and progesterone) to treat the absolutely crippling post-menopausal depression I was experiencing. I went through eight doctors, all of whom just wanted to put me on antidepressants, before I found a bioidentical hormone specialist.

“After he’d gotten all of my other hormones balanced, he added a tiny dose of time-release testosterone that shut off the depression like a light switch. And yes, in addition, it has helped stimulate a buoyant sex drive.”

Nancy reported that testosterone enhances libido:

“Taking bio-identical testosterone has increased my joy in sex exponentially and is good for me in many other ways. Whoopie!”

Mary is also enthusiastic:

“I am 67 years old. Several years ago I began a relationship with a kind and loving man. He is six years younger than I am.

“I had a very low sex drive. I do not have a uterus. My Doctor put me on bio-identical hormone pellets which contain animal estrogen and some testosterone, and voila! Sex drive back full force. I have more energy, better sleep and no beard (LOL). Now everybody’s happy. I also take micro-ionized progesterone in a pill.”

Paul offers this perspective:

“Susan Rako, MD, wrote a book several years ago called the “Hormone of Desire.” It addressed the use of testosterone in low dose as a treatment for lost libido in older women. It received quite a bit of publicity at the time. Since the FDA doesn’t approve of testosterone to enhance libido for men or women, it never caught on. But it is very interesting reading. She recommended compounding pharmacies as a source for testosterone and also addresses the safety issues.”

What do you think? Have you ever used topical testosterone. How well did it work? Did you experience any side effects? Millions of women would like to know.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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  • Islam, R. M., et al, "Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data," The Lancet Diabetes and Endocrinology, July 25, 2019, DOI:https://doi.org/10.1016/S2213-8587(19)30189-5
  • Nappi, R.E. "Testosterone for women: green light for sex, amber light for health?" Lancet Diabetes & Endocrinology, July 25, 2019, DOI: 10.1016/S2213-8587(19)30251-7
  • Basson, R. "Testosterone therapy for reduced libido in women," Therapeutic Advances in Endocrinology and Metabolism, Aug. 2010, doi: 10.1177/2042018810379588
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