I enter a patient exam room to see Mrs. Jane Doe, who is holding a chart stating that she is here for “hormonal problems".
Me: “Hi! I'm Doctor Ahmad. I'm an Endocrinologist. What brings you to our office today?”
Jane: "Doctor Ahmad…Help! My libido is falling!"
Hmmm—where do I start?
Let's examine some facts:
What is the importance of sex for women? How many people believe that a satisfying "sexual relationship" is important to their quality of life?
- 66% of women 45 to 59 years old
- 48% of those 60 to 74 years old
- 44% of those 75 years of age or older
THE GOOD NEWS: Most aspects of female sexual function is not affected by age, menopause, or testosterone concentration.
HEALTH BENEFITS OF SEX FOR WOMEN
- Helps with losing weight and gaining energy (sex burns about 150 calories every half hour)
- Improves sleep and relaxation
- Relieves pain (sex may reduce headaches and joint pains by raising endorphin levels)
- Increases longevity (sex slows the aging process)
- Decreases stress and improves mood
- Strengthens immunity
- Improves cardiovascular health and lowers cholesterol
- Increases intimacy within a relationship
THAT HAS MORE BENEFITS THAN A BAG OF DIFFERENT DRUGS COMBINED!!
So, if testosterone makes men have a higher libido, do women have testosterone too?
Yes, women have testosterone and it declines with age and becomes less after menopause. But, replacing it does not usually affect libido (except in some special circumstances). It’s hard to test for a testosterone deficiency in women and it should not done in most circumstances (your doctor can discuss the exceptions).
WE NEED TO DISTINGUISH BETWEEN DESIRE AND AROUSAL!
One's interest in being sexual depends on drive, belief, values, expectations, motivation, and not to mention–a women's self body image, the quality of her relationship, and stress level.
Hormone deficiencies cannot explain failure to have an orgasm (which is a very common sexual dysfunction in women). Other factors like pain during intercourse, vaginal dryness, and menopausal changes can also have an impact. For example, you might still have desire, but menopause can cause dryness/tightening and shortening of the vagina and decreased sensitivity of the clitoris. ALL THIS AFFECTS AROUSAL…NOT DESIRE. It's a complicated issue and requires a detailed discussion with your specialist.
THERE ARE VERY FEW QUICK FIXES…AND THERE ARE A LOT OF MISLEADING MYTHS OUT THERE!! BE CAREFUL WITH YOUR MONEY AND TIME.
Some common myths:
TESTOSTERONE CREAM–In premenopausal women it is of dubious use!! Post menopausal is a whole different discussion. Most women on testosterone compounded creams do not need to be on it! Consult a specialist before you start as testosterone therapy in women can result in serious side effects.
DHEAS–For premenopausal women it is INEFFECTIVE.
ORAL ESTROGEN/PROGESTERONE–Systemic estrogen with or without progestin therapy did not improve sexual satisfaction and may be harmful!!
PROGESTERONE CREAM–This is not FDA-approved and for good reason. There is no documented benefit of this formulation. The scant research available on hormone creams has shown that progesterone cream causes blood hormone levels that vary tremendously from person to person. This means that if two different women use progesterone cream, one could absorb hormone levels that are too low and another could receive an “overdose.”
SO WHAT ELSE IS THERE?
- Lifestyle changes (get in shape!)
- Vaginal Weights
- Explain your needs
- Sexual frequency (how frequent is enough?)
So, as you see Mrs. Jane Doe…IT'S COMPLICATED!
Shahzad Ahmad, MD, FACE
Board Certified in Endocrinology, Diabetes & Metabolism