08 Jan Testosterone for Midlife Women – Pros and Cons

I am often asked by middle-aged women who are experiencing labido (sexual drive) problems if testosterone is helpful.  We know that both testosterone and labido fall as women age.  The causes of sexual dysfunction in women are complex including stress, anxiety, depression, fatigue, emotional state of relationship with partner, partner’s performance, relationship duration, prior physical or sexual abuse, gynecologic problems, other health problems, and medications.  Although results of most large observational trials have typically found little association between testosterone levels and female sexual function, a few studies have shown a relationship in some women.

Although sexual desire and activity improved significantly in the testosterone treatment groups in these studies, placebo responses were high as well.  The other big unknown is the risk associated with testosterone supplementation in women, especially the risk of cardiovascular disease and breast cancer.  The only long-term study, 52 weeks, revealed 4 cases of breast cancer in the testosterone treatment group and none in the placebo group.  The authors could not conclude if there was a causal effect, however.  No testosterone product is currently approved for the treatment of low female labido in the United States.  Testosterone products for men such as Androgel or Testim are occasionally prescribed for women off-label but at 1/10 the usual dose for men.  Compounded Testosterone 1% cream or ointment, 0.5 gm topically applied daily to the arms, thighs, or low abdomen is another popular treatment.  Risk of over supplementing is always a concern so testosterone levels should be followed carefully if a women decides to start therapy.  Side effects may include excessive hair growth, acne, irreversible deepening of the voice, elevated liver enzymes, and elevated cholesterol levels.  Since testosterone can be converted to estrogen in the body, the risks of estrogen therapy can also apply.  In most women the problem is usually not low testosterone.  One of the other problems mentioned at the beginning of the article is much more likely to be the culprit.  Address those problems first.  If low labido continues, then consider testosterone therapy but understand the controversy and potential risks.  If no improvement in labido is seen with testosterone therapy after a few months, stop it.