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Pros and Cons of Testosterone for Women
(05/04/2004) by Unknown
Reprinted from Vol. XVIII, No. 6 (c) 1999 DKT International, Chapel Hill, North Carolina. All Rights Reserved. November, 1999
Whether they are willing to prescribe testosterone for women, physicians agree that there is a need for more research on the subject.
"There are anecdotal reports of women helped by testosterone," said Adam J. Duhl, MD, a gynecologist and instructor in maternal and fetal medicine at Johns Hopkins Medical Institutions in Baltimore. "But we have yet to see any true statistical and clinical evidence that it makes much difference."
There is also the issue of side effects: Besides aggressiveness and acne, testosterone can cause deepened voice and the growth of facial hair. In addition, said Duhl, 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." For these reasons, he has never prescribed it.
But many physicians do prescribe testosterone for female libido, and some have been doing so for years.
Since 1986, Victoria Maclin, MD, chief of reproductive endocrinology at the University of Nebraska Medical Center in Omaha, has been providing testosterone to menopausal women who had lost sexual desire and were not helped by estrogen therapy. She administers the hormone by pellets implanted beneath the skin. Maclin said this method produces very few side effects because it employs natural (plant-based) testosterone rather than the synthetic methyltestosterone used in Estratest.
Of the 100-plus women Maclin has treated with this method, only two were unable to tolerate the implant: "It caused irritation, and their bodies expelled it." The rest, she said, responded well and found themselves feeling sexual again after a hiatus of months or years.
While she considers the implants the best way to deliver testosterone, she knows of no other physician who uses them. "I’m probably in quite a minority," said Maclin, who discovered the pellets when she took part in a study about their use in women. The pellets’ original, and official, purpose is to provide testosterone to men who have a deficiency of testosterone, but Maclin administers them "off label", which is the term used when drugs are prescribed for purposes that have not been approved by the FDA.
Adam Levine, MD, formerly an instructor in reproductive endocrinology at Johns Hopkins University School of Medicine and now a gynecologist in Tampa, FL, said that to date he has prescribed male hormones to about 100 women, with largely positive results. Most of his patients have experienced a rise in libido on testosterone, with some also reporting "an increased sense of well-being."
For several years, Levine prescribed Estratest, which "worked fairly well" for libido, but caused side effects in a number of patients.
So recently, he began offering "a newer alternative," DHEA. An androgenic hormone that is produced in the adrenal glands of both sexes (and starts to decline before age 30), DHEA is closely related to testosterone. 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 also is 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, said Levine, DHEA produces fewer side effects but appears to be equally effective in restoring libido. "The problem is that there are very few sources that provide pharmaceutical-grade DHEA," said Levine. "I know of only one local pharmacy that provides it." Otherwise, the substance is available through vitamin and health-food stores, where it is difficult to account for the quality.
While Levine advocates the use of androgens to treat flagging female sex drive, he acknowledges that "there is not a lot of solid research in this area." He still recommends that women who undergo libidinal changes with menopause try estrogen therapy first.
While there is a dearth of comprehensive clinical research — for instance, the NIH has only funded studies on supplemental testosterone for men — several studies on testosterone and women’s libido have appeared in medical journals since 1995. Philip Sarrel, MD, a professor of ob-gyn and of psychiatry at Yale University and an active researcher in this area, published studies in 1998 and 1999 concluding that testosterone-estrogen therapy is far more effective than estrogen alone in increasing "sexual sensation and desire" among postmenopausal women.
Sarrel said women whose sex drive decreased with menopause (and did not respond to estrogen therapy), reported more frequent intercourse, greater interest in sex and increased clitoral sensitivity on testosterone. One study noted that women who received a combination of estrogen and testosterone also experienced less depression and fatigue than those on estrogen alone.
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