Can a testosterone patch improve female sexual desire and arousal, pleasure and overall satisfaction? Yes, but there are many things to consider before taking this route to improving your sex life.
Concerns About Testosterone for Women
First of all, the therapy has not been tested beyond six-month use. Cardiovascular and endometrial impacts have been low in studies of postmenopausal women using the patch, but no adequate trial has been conducted on breast cancer risk.
Second, there is no clinical definition for who will benefit from a testosterone patch. Effects vary by individual enzyme activity and hormone-receptor response. Measuring how much testosterone a woman has will not predict how she will respond to the therapy.
There is no testosterone level considered insufficient in women. In other words, doctors should not use testosterone levels to determine how a woman will react to the patch. They should test hormone levels, however, to establish a baseline, make sure the testosterone does not go too high on the patch, and there isn’t another cause for the lack of sexual desire.
Use of testosterone therapy is not based on a link between symptoms and biochemistry, but rather on clinical evidence that testosterone improves the most commonly reported sexual problems in women.
Third, testosterone levels in women decline most during the mid- to late 30s and 40s, yet testosterone is most often prescribed after menopause. Current data do not support testosterone therapy for pre- and perimenopausal women.
Fourth, use of the patch is “off-label,” meaning it has not been approved for this use. Only Australia has approved a 1% testosterone cream for women. In the US, the only options are products approved for men, usually prescribed at one-tenth the men’s dose.
Finally, testosterone therapy in women can cause hair loss, acne, a deeper voice, a larger clitoris, and unwanted facial hair.
Hypoactive Sexual Desire
About 10% of American women are affected by hypoactive sexual desire disorder (HSDD), which is a lack of sexual interest, erotic thoughts or desire to participate in sex acts. A person is diagnosed with HSDD only if the symptoms cause distress, frustration or grief. HSDD is considered a biopsychosocial condition with biological, interpersonal and sociocultural factors.
HSDD Viewed the Way Depression Used to Be
Today, HSDD is viewed the way depression was decades ago. Before safe and effective antidepressants were developed, depression was seen as “all in one’s head,” and the treatment was primarily psychotherapy and “getting over yourself.”
Once selective serotonin reuptake inhibitors (SSRI) became commonly used, we began accepting depression as a true medical condition with medical treatments.
Depression and HSDD have much in common. People with depression have a difficult time enjoying life; those with HSDD have lost their ability to enjoy sexual activity. Drugs being developed for HSDD have some things in common with SSRIs.
At present, only one drug has been approved by the FDA to treat HSDD: flibanserin. It is a multifunctional serotonin agonist (a substance which initiates a physiological response when combined with a receptor) and antagonist. Another promising drug is bremelanotide, a cyclic 7-amino acid melanocortin receptor agonist.
DHEA is a steroid hormone similar to one produced by the adrenal glands.
The following organizations have affirmed the use of testosterone therapy for women when “persistent, low libido impairs quality of life”:
- The International Consultation on Sexual Medicine,
- The American College of Obstetricians and Gynecology,
- The North American Menopause Society, and the International Menopause Society, and
- The International Society for the Study of Women’s Sexual Health
Nonetheless, the decision to use testosterone therapy is highly individual and should include an informed-consent discussion of its risks and benefits.