Boosting the Female Libido After Menopause : Risks

"[A spontaneous, innate sex drive similar to food hunger does not reflect reality] and isn't important to drive [a woman's] sexual interest or behaviour."
"When women talk about sexual interest, what they're really talking about is a response to the context around them, and it's this context that isn't examined properly."
Dr. Jonathan Huber, obstetrician/gynecologist, Ottawa

"[Most commercially available tests measuring testosterone in women were developed for men] which are ten times higher than they are in women."
Dr. Lori Brotto, University of British Columbia sexual health laboratory

Testosterone gels approved for men are being widely prescribed “off label” to women in doses anywhere from one-third to one-tenth the daily dose prescribed for men. Handout

No testosterone gels, creams or patches for women to use in bolstering their sexual drive are approved in Canada. Yet gels approved for male use are being prescribed "off label" to women and in doses ranging from one-third to one-tenth those prescribed as daily doses for males. There are some inconveniences in using these gels; they promote the growth of hair. Taking that into account, women rub the gels into areas like armpits: "You put it some place you don't mind seeing hair growth", explains Dr. Robert Reid, chair of the division of reproductive endocrinology and infertility at Queen's University in Kingston, Ontario.

Dr. Reid and Dr. Ann Kathryn Korkidakis are co-authors of a recent study where they pooled the results of 35 earlier studies of about 4,800 menopausal women to reach the conclusion that those who were prescribed testosterone experienced "improved sexual function scores", with a slight increase (one per month) of the number of "satisfying sexual episodes". The study grew out of the reality that women are being prescribed testosterone for low libido, even though studies question the usefulness of testosterone over placebos. This latest study was published in the Journal of Obstetrics and Gynaecology Canada.

In the interests of procreation and perpetuation of the species nature designed women to be responsive to male sexual overtures and to initiate them during their prime child-bearing years. Once that period in their lives had passed and the female body no longer produced eggs to be fertilized nature in her great wisdom must have decided there was no longer any need for females to be receptive to intercourse and the result was a hugely decreased interest in sex. But human ingenuity always seeks ways to override nature's blueprint....

Risks of side effects that face women with the use of testosterone go beyond the growth of unwanted hair, to include acne, androgenic alopecia (male pattern balding) -- horrors! -- a more masculine, lower timbre voice, or a propensity toward expressing aggression when doses are too high. Along with more negative blood fats and "as yet undetermined", long-term effects on heart disease and breast cancer, according to the study's results.

Post-menopause, testosterone production decreases in women by roughly 25 percent. For those women who have had their ovaries surgically removed, circulating testosterone decreases by a whopping 40 to 50 percent. Dr. Reid does stress that additional factors that would include fatigue, stress, relationship issues and drugs known to suppress libido such as anti-depressants, should be ruled out before a woman is prescribed testosterone. Even then, he says, a third of women may benefit while "The other two-thirds come back and say it didn't make any difference. So I say, well, stop it."

The working theory on the use of testosterone is to prime the brain to become more alert to sexual cues. Yet it is not fully understood at what level a woman can be diagnosed as "deficient". For her part, Dr. Lori Brotto fears the paper may lead to wider off-label prescriptions to women. She no doubt bears in mind a U.S. Food and Drug Administration advisory panel rejected approving a testosterone patch developed by Procter & Gamble for women in 2004, on the basis that insufficient safety data was available.

In addition to which Canadian and American regulators two years ago issued new alerts linking testosterone replacement products with an increased risk of heart attack and stroke. Health Canada has had Valeant Pharmaceutical's Addyi, a drug for low libido in women, under review for over a year. The cost is prohibitive at $800 monthly, and the fact that there is a warning it cannot be taken with alcohol may have curbed uptake, since Amerian sales of the product have been poor.