Testosterone for Women – The Libido Link

The significance of hormones in relation to sexuality is widely acknowledged. Androgen refers to any hormone that has a masculinising effect on either sex. They are associated with sexual desire for both sexes. The dominant androgen – testosterone – in men is produced mostly by the testes and in small quantity by the adrenal glands, and in women, in much smaller quantities, by the ovaries and adrenal glands.It is important to realise that about 95% of the testosterone circulating in a man’s blood system is bound (on a protein molecule) and therefore metabolically ineffective. The degree of impact of testosterone on an individual’s sexual drive is determined by the remaining amount of free testosterone, which is metabolically active and influences the libido. For males that is about 5%; and for females the free testosterone, which produces effects on bodily tissues, is only 1 to 3% of the total testosterone. A higher level of androgen is required for male sexual desire than for female desire, so normal is different for men and women.In terms of sexual function, estrogen enhances sensitivity to sexual activity and creates a physical climate conducive for sexual behaviour. It helps the vaginal tissue remain elastic and contributes to lubrication. Despite all of the research that has been done on the hormone estrogen, its role in sexual desire remains unclear.In women testosterone produced by the ovaries fluctuates during the menstrual cycle, the highest amount being produced, along with estrogen, at ovulation. Androgen insufficiency in women has also been found to be associated with hypopituitarism (deficiency of pituitary hormones), adrenal insufficiency, ovarian failure, and oophorectomy (the surgical removal of an ovary). However, with menopause, the ovaries naturally decrease their production of testosterone. It is not necessarily a specific consequence of natural menopause but can occur as a secondary factor to the age-related decline in the adrenal and ovarian androgen production.Millions of women have over the decades used hormones to treat the symptoms of both natural and surgical menopause. Typically, hormone therapy consists of supplemental estrogen, sometimes combined with progesterone. In addition to helping protect menopausal women against heart disease and bone loss, hormone therapy has been effective in treating menopause symptoms such as flashes, mood swings, sleeplessness, and the range of conditions that can adversely affect a woman’s sex life, including vaginal shrinkage, dryness and loss of elasticity.However, some women are unable to tolerate the side effects of estrogen therapy, which include headache, nausea, bloating, leg cramps, breast tenderness and engorgement, irregular vaginal bleeding and staining, and over-secretion of mucus (heavy vaginal discharge). Some of these are however due to progestin and lowering the dosage of either or both hormones may relieve these problems.Despite the fact that estrogen therapy may reduce the somatic symptoms of menopause, it often does not provide adequate restoration of the woman’s sexual desire. Several testosterone products originally developed for men have found application with naturally and surgically menopausal women with low sexual desire. The testosterone formulations used with women include products that can be administered as a pill, a patch, or a cream that is applied topically to the vulva, wrists, or thighs.Often, estrogen when used alone is some women, is enough to maintain normal female well-being, including sexual desire and activity, but testosterone often needs to be added to ensure robust, dependable sexual desire and response. Besides boosting sex drive, the hormone can help relieve hot flashes and other conditions related to menopause; and thus an effective option for women who cannot tolerate high levels of estrogen.Several studies have also concluded that testosterone-estrogen therapy is far more effective than estrogen alone among postmenopausal women. Most women have reported more frequent intercourse, greater interest in sex and increased clitoral sensitivity on testosterone. Some women have also been noted to experience less depression and fatigue than those on estrogen alone.However, because testosterone effects in women have not been widely researched and no testosterone therapy has been approved by the FDA for the treatment of female hypoactive sexual desire disorder (HSDD), most physicians apparently prescribe the hormone “off-label”. It is mostly prescribed to patients who have tried estrogen-based hormone therapy without success (and in few cases, to premenopausal women who are found to have “extremely low” levels of testosterone).Side effects of testosterone include secondary male sexual characteristics, aggressiveness, and deepened voice, growth of facial hair, enlargement of the clitoris, acne, weight gain, and liver damage. In addition, it has been shown to lower the rates of HDL, the “good” cholesterol, while increasing heart-harmful LDL cholesterol – the exact opposite of what estrogen does. In the very low dosages prescribed for women, however, these side effects are very unlikely to occur and can be controlled additionally by reducing the dosage further when necessary.Other doctors have started offering a new alternative, DHEA. It is an androgenic hormone that is produced in the adrenal glands of both sexes but starts to decline before age 30. DHEA is closely related to testosterone and in fact, the body has the ability to convert DHEA into other hormones, including estrogen and testosterone.The hormone plays an important role in sex drive. Taken as a supplement, it is also said to bolster the immune system and delay the physical signs of aging. But little is known about the long-term effects of taking DHEA. Because it is weaker than the testosterone used in Estratest (not approved by the FDA for any indication – nonetheless on the market – a situation that is said to exists because of “complicated legal reasons”), DHEA produces fewer side effects but appears to be equally effective in restoring libido.
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