I was thrilled when the FDA approved Addyi®, the first drug for women with hypoactive sexual dysfunction disorder (low libido or sexual desire). Sexual problems are reported by 40% of women in United States and show a peak in midlife women, aged 45-64. Sexual dysfunction can have multiple factors including depression, anxiety, fatigue, stress, relationship issues, prior sexual abuse, medication side effects, or physical conditions that make sex uncomfortable including vaginal atrophy. Addyi works on the brain chemistry and may not be an option for all women with low libido due to side effects and restrictions. Another factor that may contribute to sexual dysfunction is decreased testosterone levels. A large series of multicenter, randomized, placebo-controlled studies using 0.3mg testosterone patches showed improved libido in selected postmenopausal women.
Symptoms of decreased testosterone include low libido, fatigue, decreased muscle mass, body hair loss, and depression. For women experiencing these symptoms, speaking to your physician about evaluating your testosterone levels may be an appropriate step. Although testosterone is traditionally known as the “male” hormone, women do produce and need this hormone, although in significantly lower amounts. Normal serum levels of total testosterone for men can range between 350 and 1000, whereas women fall between 15 and 75. If levels are low, supplementing with a topical testosterone cream could supply relief for symptoms.
The FDA has not yet approved a specific product for testosterone replacement in women so compounding is one of the few options for physicians who wish to treat women. The products approved by the FDA for men, such as Androgel® or Testim®, contain higher doses of testosterone than women would need. The average dosage necessary for a woman would be 0.5mg to 3.0mg per day of testosterone transdermal cream. Some women do need higher dosages due to absorption issues, but the physician would determine that over time. Even better, testosterone does not need to be applied daily for women to reap the benefits. It can be used 3 times weekly if desired. This frequency often resolves symptoms and prevents the dose from building over time. A woman on testosterone replacement experiencing excessive oily skin, acne or aggression should contact her physician. Those symptoms mean a new testosterone level should be obtained and then the dosage either discontinued or lowered.
Shifren JL et al. Sexual Problems and distress in United States women: prevalence and correlates. Obstet Gynecol 2008;112:970-978.
Shifren JL et al. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Engl J Med 2000;343:682-688.
Shifren JL et al. Testosterone patch for the treatment of hypoactive sexual desire disorder in naturally menopausal women; results from the INTIMATE NM1 Study. Menopause 2006;13:770-779