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Testosterone can boost women's sex drive The Ottawa Citizen: 27 November 1998: Testosterone - the male hormone - is helping to boost sexual desire in some menopausal women. With Viagra boldly to the rescue of men with sexual dysfunction, women's sex problems are emerging from embarrassed secrecy. Some doctors are touting testosterone-replacement therapy as a powerful libido booster for women robbed of desire by menopause symptoms. In fact, the Society of Obstetricians and Gynecologists of Canada will issue new menopause guidelines next month that strengthens its position on androgen [male hormone] therapy. The Society, which last issued such guidelines in 1994, will suggest that doctors use the therapy to treat libido problems in women with natural menopause when there is no other explanation for loss of sexual feeling. In its 1994 guidelines, the Society merely noted that androgen therapy was available for women who experienced menopause after a total hysterectomy, or removal of ovaries, as well as those with natural menopause. "A lot more research has been done in the last four years, expanding the possibilities for testosterone", said the Society's Rosemary Killeen. "Women are becoming more aware of it." Los Angeles gynecologist Dr. Judith Reichman, in her new book on improving female libido called 'I'm Not In The Mood', calls hormone replacement therapy a "godsend to many women. "We are now at the threshold of a similar revolution when it comes to male hormones", she writes. Testosterone can re-ignite passion, increase energy, lift depression, and strengthen bones. "Women can feel wonderful", says Dr. Elaine Jolly, chief of gynecology at the Ottawa Hospital's General site. Doctors have known about testosterone's effects on women for decades, but it has been most commonly prescribed for women who have had their ovaries surgically removed or had radiation or chemotherapy. Now, it is being revisited as a treatment for women in natural menopause. But testosterone has a dark side - even in lower doses testosterone can cause acne, facial hair growth or male pattern balding. Its long-term effects are unknown, and some research has suggested it may increase a woman's chances of developing heart disease. Few women realize it, but they produce testosterone in their ovaries and adrenal glands. Testosterone is the hormone that produces fantasy, desire, sensitivity and probably enhances orgasm. It's what causes teenagers to become interested in the opposite sex during puberty. The level of testosterone in women declines as they age. In older women, this can be accompanied by diminished sexual desire and arousability, inability to climax, loss of pubic hair, skin thinning and diminished sense of well being. Research shows that about 40 per cent of women in menopause experience loss of libido. "A lot of women are not willing to go out and talk about it", Dr. Reichman said in an interview. "They feel ashamed. We're still back 30 years, maybe we shouldn't enjoy sex, much less want it." When a woman reaches menopause - the average age is 51 - doctors often recommend she consider taking hormone-replacement therapy, usually a combination of estrogen and progesterone. Hormone therapy is used to relieve symptoms such as hot flashes, night sweats, insomnia and vaginal dryness. Studies have shown that estrogen can prevent heart disease and bone fractures from osteoporosis. According to surveys, between 17 and 28 per cent of menopausal women in Canada take hormones. Dr. Reichman said that adding testosterone to hormone-replacement therapy can help women with a lack of sexual interest where low testosterone is the culprit. "This is where nothing turns you on, not an erotic movie or pictures of male models", she says. A blood test can measure testosterone levels. Medication, stress, weight loss and fatigue can also affect testosterone levels. "I have seen many 20- and 30-year-olds who need it", says Dr. Reichman. While there is much data on men on diminished libido and erectile dysfunction, there is little on women, Dr. Reichman said. "Seeing is believing", she said. "When man has a problem, he and his partner know about it. When a woman has a problem, who knows but she?" No one knows exactly how many women are taking testosterone, but Dr. Jolly said it is underused. Women are afraid of the side effects, and physicians don't know how to fine-tune dosages to prevent them. "The real problem is we don't have a good formulation for women", she said. The only testosterone in pill form available in Canada is for men, and the dosages are too high for women. Some doctors prescribe them for women, but the pills are broken in half or taken every other day. A drug called Livial, which contains estrogen, progesterone, and a small amount of testosterone, is expected to be approved in Canada by 2001. Ottawa gynecologist Dr. Norman Barwin participated in a clinical trial for Livial. Although it is not yet approved for use in Canada, Dr. Barwin applied to the health protection branch to allow 50 of his patients to continue using it on compassionate grounds when the trial ended. "These patients don't want to go off it", he said, noting it relieved their depression, fatigue and loss of libido. An injectable testosterone called Climacteron became popular in the '70's and '80's, but some women grew beards and became aggressive because the dose was too high. Dr. Jolly said Climacteron can be used if it is diluted with estrogen. Doctors can also get testosterone creams and lozenges specially made up in pharmacies. Dr. Jolly said doctors need more education about the use of testosterone, and more studies are needed. "The most common sexual problem in older women is lack of a functioning partner", added Dr. Jolly. "If you're not in the mood because of an unhappy marriage, you mustn't assume it's testosterone". Testosterone shouldn't be taken by women who might become pregnant, have a high risk of heart disease, liver disease or previous breast cancer. Janine O'Leary Cobb, Montreal author of 'Understanding Menopause', said she doesn't believe most women with a normal menopause need testosterone. "It goes hand in hand with face lifts and liposuction: let's not grow old." She said in many cases flagging sexual desire is not permanent. Testosterone is "not a magic bullet", agreed Dr. Reichman. "its not going to cure all of our libidinous woes." by Maria Bohuslawsky The Ottawa Citizen janet paterson - 51 now /41 dx /37 onset - almonte/ontario/canada [log in to unmask]