Is There A Role For Testosterone?

Loss share here of or Low Libido — Women.

Hypoactive Sexual Desire Disorder in Women.

Definition: It would be as well to remind ourselves again, so as to avoid any confusion that female sexual response may be thought of as arriving in four separate and distinct phases. First described by Masters and Johnson in 1966 those four phases of sexual response were: Excitement, Plateau, Orgasm and Resolution. Of course we now accept that these responses are not as cut and dried as once thought. They are rather a continuum that blend and fuse and that require emotion and feelings for them to work in the first place. Also, other things have changed since 1966. While most people might still agree in principle about the usefulness in phasing sexual response for the purposes of therapy, the phases themselves have been changed and reduced to three. Today these are:

(1) LIBIDO: This is interest or desire or sex drive or lust or sexual urge. You can even call this first phase appetite, craving or sexual hunger. It is NOT however arousal or horniness or the hots, because those are completely separate and later phases of the human sexual response.

(2) AROUSAL: This is what starts to happen as a result of sexual stimulation in a woman who has normal libido. If she has not got normal libido then she is not going to get to the arousal phase of sexual response.

(3) ORGASM: When stimulation is sufficient to bring about a high enough degree of sexual excitement the orgasm should take place.

Again, these three phases of sexual response are mentioned here only for the purposes of clarity when it comes to targeting therapy. They are not being put forwards as in any way necessarily, stereotypical, ideal or always achievable. Furthermore, it is acknowledged that for libido, arousal or orgasm to occur at all, emotions, feelings and attraction are also essential requisites.

If I seem to be labouring this point it is only because, almost on a daily bases, I see people confuse libido with arousal, response and orgasm, such that it is impossible to focus in on their particular dysfunction with any clarity. Even if reached somewhat artificially, clarity in this area is, in my view, essential for progress. Otherwise there is just endless confusion and no progress.

To return to definition then: Lack or loss of libido in a woman, may be defined as the persistent or recurring absence or near absence in her of any interest ,sexual desire or urge to engage in sexual activity with another person for whom she might feel otherwise attracted.

What are the causes of Hypoactive Sexual Desire in Women?

Causes of Hypoactive Sexual Desire Disorder in women (low libido) can be divided into Physical and Psychological:

Physical Causes.

(1) Menopausal collapse of one or other of the sex hormones estrogens, progesterone and testosterone.
(2) Pregnancy, childbirth more information and breast feeding.
(3) Medications like the birth control pill, SSRI鎶?or any antidepressant, sedative, anti-psychotics, anti hypertensives and chemotherapy.
(4) Excess alcohol or illicit drugs.
(5) Chronic illness, stress, emotional upheaval, diabetes, arthritis, chronic renal disease, chronic heart failure, raised blood pressure, chronic neurological disease like MS, spinal cord injury, Parkinson鎶?, chronic fatigue syndrome, motor neuron disease etc.
(6) History pain during intercourse ?dyspareunia. Fear of pregnancy. History child or adult sex abuse.
(7) Obesity or anorexia.

Psychological Causes.

(1) Depression, stress, anxiety, hostility, anger.
(2) Poor body image.
(3) Relationship issues.

Treatment of Low Libido in women.

In the first instance every effort needs to be made to identify the underlying cause or causes of failing libido. All the above possible causes and much more need to be considered and ticked off in a mental list. You will need to treat the underlying cause or remove it where possible. There is simply no point in hoping that HRT, for example, is going to rekindle a flagging libido when the underlying cause remains unaddressed.

If there is no treatable underlying cause, and often there may not be, then the woman鎶?general physical and emotional health need to be look at. If overweight she should be encouraged to take regular exercise and to make life-style adjustments designed to increase her overall levels of fitness and wellness.

Hormonal Replacement Therapy.

In my Internet online practise the vast majority of women presenting with low or no libido are doing so because they are menopausal or post-menopausal. Some of these women may have been on HRT at an earlier stage but may have discontinued this treatment owing to understandable safety concerns.

It is important though to keep these safety concerns in context. For every 10,000 women not on HRT one might expect to see 30 new cases of breast cancer among them each year. Given HRT as an oestrogen/ progesterone combination, that figure can be expected to rise to 38 new cases of breast cancer per year for every 10,000 women so treated. Therefore, the increased risk for women on combination HRT is eight cases per 10,000. That is significant but hardly alarming.

Consider these two factors as well:

(a) Where a woman has had a hysterectomy it will not be necessary for her to take progesterone since she will not need the protection against developing endometrial cancer posed by her taking oestrogen. Women who take oestrogen alone have on average a 30% reduced risk of developing breast cancer. As she grows older this figure decreases monster legends hack tool online and no one is advocating oestrogen as a protector against cancer. The finding does however show this hormone up in a very good light.
(b) One of the most troublesome symptoms of menopause is vaginal dryness. Vaginal dryness occurs in 45% of menopausal and post-menopausal women. This gives rise to painful intercourse (dyspareunia) in 41% of post menopausal women. The most effective treatment for vaginal dryness is vaginal oestrogen cream and this does not raise blood estrogens by any detectable amount.

Where oestrogen / progesterone combination are necessary to control menopausal symptoms the progesterone component of therapy can be administered in a cyclical manner further reducing long-term side effects.

What about Testosterone Replacement Therapy for Women or TRT?

Women produce testosterone from their ovaries and adrenal glands at levels of about one tenth of that of men. As with men, this level of testosterone falls with age. After menopause a woman鎶?testosterone levels will be very low indeed. Testosterone plays an important role in sex drive or libido in both men and women. Not all women鎶?libido is adversely affected by lower testosterone levels but some undoubtedly are.

Testosterone replacement therapy is now recognised as a legitimate if unapproved therapy for women with low libido. Getting the dose right is very important if nasty side effects are to be avoided. Common side effects of TRT in women are lowering of voice, development of acne and facial hair growth none of which woman welcome.

Since woman鎶?testosterone levels are approximately one tenth of that of men their TRT dose need to be no greater than one tenth of that taken by men. For example men take a TRT transdermal gel called Testogel or Androgel. The recommended daily dose of this in men is one or two tubes containing 50mg of testosterone. On a purely empirical bases then the recommended daily dose of this for a woman would be 5mg daily or one tenth of a tube.

For ease of administration I usually recommend that a woman empty the contents of a tube into a 5cc graded syringe and administer one tenth of this onto her skin (forearm) each day. If after a month of this treatment the woman notices no improvement in her libido then the dose may be doubled. If that does not bring about an improvement in sex drive then TRT is probably not going to work.