Testosterone treatment – can it help with low libido?
Author: Chris Jones
Chris Jones, a Women’s Health Care Nurse Practitioner, from YourGynNP.com discusses the pros and cons of testosterone treatment to help women who are suffering with low libido during menopause.
When a woman does report low libido that she considers to be a problem, it’s called “hypoactive sexual desire disorder” (HSDD). Some women do notice decreased sexual interest, but it’s not a problem for them.
As we explored in my recent article Low libido during menopause – why is this happening?, decreased sexual desire during menopause can be due to multiple possible physical and/or psychological reasons. One physical explanation, however, can be related to lower levels of testosterone women produce during menopause. The hormone testosterone is fundamental to sex drive and feelings of desire.
Firstly, before considering testosterone treatment, it is important to evaluate the issues that may be affecting you and try to take action regarding any life-related and/or medical concerns. Then, if symptoms persist, and a woman’s testosterone level proves to be below the normal premenopausal range, testosterone treatment can improve issues of decreased sexual interest during menopause in some, but not all women.
In menopause, testosterone levels decrease by a little over half.
This is why some women’s health care providers and alternative medicine enthusiasts recommend testosterone treatment for menopausal women to treat complaints of low libido.
It’s important to be aware that because the ovaries stop producing oestrogen in menopause, a woman’s remaining testosterone becomes relatively more potent.
One should consider this more biologically active/free testosterone (due to the lower oestrogen in menopause) when evaluating the normally lower testosterone levels in of menopause. Keep in mind that that lower number is a bit more potent than it appears.
Prior to prescribing a testosterone in menopause, your gynae professional will check your testosterone to be sure it is below the normal premenopausal range. Testosterone levels are most accurate if measured in the blood (not saliva) at about 7-8am. If measured outside of that time period, an incorrectly low level may result. If one is on any medication from the steroid drug family (example: prednisone), a falsely low result may also occur.
Normal total testosterone levels vary. According to A Manual of Diagnostic Tests, the level of testosterone in men ranges from 300 to 1000 ng/dL. Compare the levels in men to that of:
Premenopausal women: 20-70ng/dL
Postmenopausal women: 8-35ng/dL
This very significant difference between male and female levels of testosterone may help to explain why women, although definitely sexual beings with feelings of desire, are more susceptible to the long list of life issues that often (some women would say “usually”) distracts them from sexual interest. Examples – stress, fatigue, relationship issues, and many more.
Sexual interest might be lower in a woman who is on oral oestrogen (which decreases free testosterone) than if she were using topical oestrogen (which does not affect free testosterone levels). Patch, cream, mist or gel are all topical routes.
This is why it is important to take into consideration whether or not you are on, or plan to start, oestrogen replacement, plus think about the route (method) that the oestrogen is used.
If you are on oral oestrogen, ask your gynae provider to consider changing to a topical route. You may then notice the effect of more sexual desire through your own remaining testosterone. In this case, you can avoid adding yet another medication.
Bonus: topical oestrogen does not have the same increased risk of stroke blood clots in the legs and lungs as does oral oestrogen.
There is currently no approved, standardized testosterone treatment for women in the USA or Europe. Estratest (an oral form of oestrogen and testosterone in the USA was withdrawn from the market. The Intrinsa testosterone patch was available in 6 countries in Europe. It was prescribed to treat women who had surgical menopause (ovaries removed) and were also on oestrogen replacement. However, Intrinsa patch was discontinued in 2012 “for commercial reasons”. Compounded testosterone cream may be available, depending on the prescribing provider and pharmacy, however, it is not considered “standard practice.” and would have to be prescribed “off label”. It is definitely not recommended to use testosterone pellets or injections for reasons previously discussed.
In summary, firstly evaluate medical, social, daily life and relationship issues that may be contributing to loss of sexual interest. Next, implement the changes that seem right for you and, if on oestrogen replacement, change to a topical route. And finally, if problematic low libido still persists, then testosterone treatment may be an approach worth consideration.
1. As with any medication there are risks involved as well as benefits. Side effects and serious health risks of testosterone treatment increase if testosterone levels during treatment are in excess of the normal premenopausal female range. Excessive testosterone levels, side effects, and serious health risks are likely if testosterone is taken orally, or by implanted pellet or injection. We advise discuss risks and benefits of testosterone treatment thoroughly with your gynae professional before starting testosterone or any new prescriptions.
2. I have not discussed progesterone/progestin replacement as it is not within the scope of this article. But be aware that if one still has a uterus, and is taking oestrogen, that it is essential to also be on a progesterone/progestin replacement in addition to the oestrogen (unrelated to whether one is or is not on testosterone). This is absolutely required because it very effectively prevents a high risk of developing cancer of the lining of the uterus (endometrial cancer) from taking “unopposed oestrogen.” The pros and cons of oestrogen replacement therapy with and without progesterone/progestin are discussed in detail in YourGynNP’s printable summary: HRT – Pros and Cons
About the Author
Chris Jones is a Women’s Health Care Nurse Practitioner, specialising in women’s health issues and Hormone Replacement Therapy. She can provide practical, easy to understand information to help you decide if and how Hormone Replacement might be right for you.
You can contact Chris via her website at: YourGynNP.com
Associations among Oral Estrogen Use, Free Testosterone Concentration, and Lean Body Mass among Postmenopausal Women – https://academic.oup.com/jcem/article/85/12/4476/2852241
High and Low Testosterone Levels in Men – https://www.medicinenet.com/high_and_low_testosterone_levels_in_men/views.htm
Polycythemia From Testosterone Therapy: To Treat or Not? Darrell Hulisz, PharmD, November 01, 2012 – https://www.medscape.com/viewarticle/773465
The Endocrine Society in 2014] Practice Guideline Nixes Testosterone Therapy for Women – https://www.medscape.com/viewarticle/832898
Testosterone replacement therapy for physician assistants and nurse –
The Safety of Postmenopausal Testosterone Therapy, Kate Maclaran, Nick Panay* First Published May 1, 2012 Review Article – http://journals.sagepub.com/doi/10.2217/WHE.12.11
Testosterone Levels by Age – https://www.healthline.com/health/low-testosterone/testosterone-levels-by-age