Low libido (defined as low desire for sexual activity) in women has traditionally been a challenge to treat. For many years, low libido was thought of as being only in a woman’s “head”, or as a secondary consequence of other medical problems. However, as we are becoming more educated about the roles that hormones play in the human body, the medical community has begun to change the way it is thinking about testosterone. Typically considered a male hormone, we now know that testosterone is also critical to the sexual functioning of women. Testosterone is produced by the ovaries and adrenal glands, and peaks in our 20’s. It then slowly declines to very low levels, especially after menopause. While the replacement of testosterone in women has drawn controversy in the past, the judicious use of the hormone to restore healthy “premenopausal” levels has recently been formally endorsed by several of the major academic communities in menopause, endocrinology and sexual health.
When starting testosterone replacement therapy (TRT) in women, we usually prescribe either a topical gel that is applied to the skin of the leg daily, or a pellet that is implanted by the practitioner under the skin of the buttocks (once every 12 weeks). There are several advantages to either form of therapy, which we will review next. However, whether you use a topical product or a pellet, you can be sure that you are using a bioidentical form of the hormone. This means that the molecular structure of the hormone being administered is identical to the testosterone made by the human body. These forms of hormone replacement therapy are thought to be superior, since they are likely better metabolized by the body and thus lead to greater symptomatic improvement. The next question you may be asking yourself is, “which kind is right for me”? Well, if you are using testosterone for the first time, it often makes sense to start with the topical form. This is because it is easier to dose a smaller amount, and we can slowly titrate up to the most effective dose while still minimizing potential side effects. The disadvantages here are that it requires the DAILY application of a product which some women find burdensome. It can also sometimes take longer to see symptomatic improvements when using the gel form of the hormone. Pellet insertion is a great option for women who have used TRT in the past, and are ready to switch to a more “low-maintenance” method of administration. However, this method does require an in-office procedure and can be more expensive.
Obviously, potential side effects are of great concern to women who choose to take hormone replacement in any form. Most women who take TRT do not experience any significant side effects when the medication is administered under the guidance of an experienced practitioner. While not FDA approved for women, we know that TRT is very safe to use when bloodstream levels are kept in appropriate ranges and monitored on a regular basis. The most common side effect that we see is hair growth, which is usually at the site of gel application. Other possible, but rare side effects include acne, hair loss on head, increase in cholesterol, aggressive behavior, voice deepening and clitoral enlargement. We also often get asked if testosterone replacement can lead to cancer in women. Studies have not shown there is any direct link between TRT and cancer. It is also important to note that getting pregnant while undergoing testosterone supplementation is contraindicated, so using a reliable form of birth control is imperative. Women who are deciding if TRT are right for them should have an in-depth conversation with their provider about the risks and benefits, and what is involved to maintain safe levels in the body.
The bottom line? Testosterone supplementation is a very safe and effective treatment for low libido in women, especially when given in conjunction with behavioral therapy. We here at Maze are unique in that we take an integrative and holistic approach to care – providing both the medical and behavioral modalities required to be successful in restoring libido. Contact us for a free phone consultation and find out if testosterone replacement therapy is right for you.