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How a 'male' hormone can help women have better sex

Women are finding pleasure in the hormone that gets a bad name from amped-up males: testosterone.

At 70, actress Jane Fonda spoke out about using testosterone to boost her libido. Among experts, though, there have been years of debate about the wisdom of this therapy for women. Although it is generally thought of as a male hormone, testosterone is produced naturally in women’s bodies – although in much smaller amounts – and as they age, decade-by-decade, the levels drop. How this affects health, and whether there is any benefit in replacing the lost hormone, has been the big question.

Now, for the first time, a global position statement on testosterone treatment in women has been released by the International Menopause Society. It follows research by Australian endocrinologist Susan Davis, who has found there is a clear benefit for the sexual well-being of women post menopause.

Her work has shown that in mid-life, about 30% of women have low desire that causes them distress. “It’s common – I see a lot of women with this issue,” says Davis. “They say it’s like a light has been turned off and they don’t want to feel that way. It bothers them.”

Davis found no evidence for testosterone helping any of the other symptoms of menopause such as hot flushes, mood disorders or bone loss. But treatment with the hormone did improve sexual desire, pleasure, arousal and orgasm. And women who took testosterone were less likely to experience concern or distress about sex.

Susan Davis. Photo/Supplied

It is common for men experiencing sexual dysfunction to seek medical help. Women in the past may have been less likely to talk about it with their doctors and ask for a solution. But we are living longer now, points out Davis, so want to continue to be sexually active for longer, too.

“I think we’ve moved the goalposts, so we have to offer women at least a choice,” she says.

One issue has been that everything to do with testosterone has been designed for men. This has meant the blood test hasn’t been sensitive enough to accurately measure a woman’s far lower level of the hormone. And the treatment – usually injections or patches – delivered a man-size dose.

Too much testosterone is harmful for women, causing anything from acne and excess hair on the face and body, to a permanently lowered voice. So the correct dose is crucial.

So far there is only one testosterone treatment designed for women, AndroFeme, developed in Western Australia and available here on prescription, generally from a specialist.

Auckland endocrinologist Stella Milsom says that although it is great to have more understanding about the use of testosterone in women, it still wouldn’t be the first solution she would reach for.

The female libido is not all about hormones, she points out. “Relationships, past experience, stress, mood, other health issues and whether you’re just plain exhausted can all affect it just as much.”

Stella Milsom. Photo/Supplied

If falling levels of hormones do turn out to be the cause, most women can be treated with the more conventional HRT drug oestrogen. If a woman still has her uterus, oestrogen is always taken with progesterone to reduce the risk of cancer.

“Testosterone is another tool for women who haven’t responded to first-line treatments,” says Milsom. “Not all women respond, but when they do, it alleviates their distress around the lack of desire.”

Fonda quit testosterone treatment because it gave her acne. Weight gain and hirsutism are other potential side effects, although, in her research, Davis found this wasn’t serious enough to put women off taking it.

Short term, it seems there are no serious risks to women taking testosterone. But careful monitoring is advised, to be sure the levels are in the normal range and it is providing enough benefit. Longer term, it is not yet known whether it will have any effect on the risk of developing cardiovascular disease or breast cancer.

After looking at 46 reports involving 8480 women and finding significant benefit for sexual well-being, Davis believes women deserve to have the option.

“If you’re 30 and you’ve had your ovaries removed because of endometriosis, you should have a choice, or if you’ve had premature ovarian failure. Everybody should have a choice, from the woman who says it’s all going downhill with her husband, to the single woman who would like to have a partner and feel sexual again.”

This article was first published in the September 28, 2019 issue of the New Zealand Listener.