Given the unapproved standing of testosterone for girls within the U.S., it’s just about inconceivable to trace the variety of prescriptions disbursed particularly for this function.
For the previous couple of years, Shanahan, an ob-gyn in South Lake Tahoe, CA, has prescribed supplemental testosterone (in ointment or tablet kind) for sufferers who’ve skilled a lack of sexual curiosity with the onset of menopause. These have been sufferers who had not been helped by conventional hormone alternative remedy (HRT).
Of the roughly 70 girls who’ve used the ointment (a 2 p.c testosterone resolution, utilized to the exterior genitals), about half observed a major improve of their intercourse drive. For many who didn’t, Shanahan prescribed Estratest (manufactured by Solvay), an oral drug combining estrogen and testosterone.
Shanahan mentioned extra girls skilled a libido enhance from Estratest, which delivers extra testosterone than the genital ointment. However numerous girls taking the tablet additionally skilled testosterone-related negative effects together with oily pores and skin, zits and, in a couple of circumstances, “aggressive habits.”
For some sufferers, the negative effects have been purpose sufficient to discontinue the drug. One lady who give up Estratest as a result of it made her really feel aggressive.
What Can a “Male” Hormone Do for Girls?
Testosterone, the first male intercourse hormone, has been related to such archetypal “male” traits as aggressiveness and lively libido. Though testosterone is an androgen (male hormone), it is also produced by girls, and is, in each sexes, the chief hormone concerned in intercourse drive.
Each women and men manufacture the hormone of their adrenal glands. Males’s testes produce extra testosterone — about 10 occasions as a lot — whereas girls launch smaller quantities from their ovaries. With menopause, although, the ovaries lower their manufacturing of testosterone.
Even after menopause, most ladies proceed to launch sufficient testosterone from the adrenal glands to keep up an lively intercourse drive. However others expertise a gradual or sudden lack of curiosity in intercourse.
Therefore, some medical doctors have taken to prescribing testosterone dietary supplements for girls though the apply remains to be thought of controversial in america in comparison with Britain, the place it’s extra widespread and accepted.
Susan Cruzan, a public affairs spokesperson for the U.S. Meals and Drug Administration, mentioned, “There aren’t any testosterone medication which might be FDA-approved to be used in girls [for the treatment of sexual health].” (Estratest, although not FDA-approved for any indication, is nonetheless available on the market, a state of affairs that exists due to “sophisticated authorized causes,” notes Cruzan.)
For many years now, thousands and thousands of American girls have taken hormones to deal with the signs of pure menopause or for surgical menopause, which refers back to the elimination of the ovaries for medical causes. Sometimes, HRT consists of supplemental estrogen, generally mixed with progesterone. Along with serving to shield menopausal girls in opposition to coronary heart illness and bone loss, HRT has been efficient in treating menopause signs similar to sizzling flashes, temper swings, sleeplessness, and the vary of circumstances that may adversely have an effect on a lady’s intercourse life, together with vaginal shrinkage, dryness and lack of elasticity.
Girls who’ve turned a chilly shoulder to lovemaking due to intrusive menopause signs continuously discover aid with HRT. Surveys present that even non-sexual signs of menopause, like temper swings and fatigue, can disrupt need.
Assuaging signs like these, in addition to the vaginal circumstances that may make intercourse extra painful than pleasurable, is usually sufficient to revive a lady’s need for sexual exercise. And, in response to Theresa L. Crenshaw, MD, estrogen additionally can assist restore a lady’s “receptive” intercourse drive, making her extra responsive to the touch and prepared to be approached sexually by her accomplice.
However for girls whose lack of sexual curiosity shouldn’t be helped by conventional HRT, supplemental testosterone could provide another.
“Whereas estrogen, when used alone, is usually sufficient to keep up regular feminine well-being, together with sexual need and exercise,” writes Crenshaw, “testosterone usually must be added to make sure strong, reliable sexual need and response.” In addition to boosting intercourse drive, the hormone can assist relieve sizzling flashes and different circumstances associated to menopause, and is thus an possibility for girls who can’t tolerate excessive ranges of estrogen.
As a result of testosterone’s results in girls haven’t been broadly researched, Shanahan mentioned she solely prescribes it to sufferers who’ve tried estrogen-based HRT with out success (and in a couple of circumstances, to premenopausal girls who have been discovered to have “extraordinarily low” ranges of testosterone).
Clearly, the curiosity is there: When Shanahan appeared final yr on TV’s “Oprah” to debate testosterone’s influence on postmenopausal feminine libido, the response was enthusiastic. “After that present, girls have been calling me each day,” Shanahan mentioned.
Professionals and Cons of Testosterone for Girls
Whether or not they’re prepared to prescribe testosterone for girls, physicians agree that there’s a want for extra analysis on the topic.
“There are anecdotal experiences of girls helped by testosterone,” mentioned Adam J. Duhl, MD, a gynecologist and teacher in maternal and fetal medication at Johns Hopkins Medical Establishments in Baltimore. “However we’ve but to see any true statistical and scientific proof that it makes a lot distinction.”
There may be additionally the difficulty of negative effects: In addition to aggressiveness and zits, testosterone could cause deepened voice and the expansion of facial hair. As well as, mentioned Duhl, it has been proven to decrease the charges of HDL, the “good” ldl cholesterol, whereas growing heart-harmful LDL ldl cholesterol — “the precise reverse of what estrogen does.” For these causes, he has by no means prescribed it.
However many physicians do prescribe testosterone for feminine libido, and a few have been doing so for years.
Since 1986, Victoria Maclin, MD, chief of reproductive endocrinology on the College of Nebraska Medical Middle in Omaha, has been offering testosterone to menopausal girls who had misplaced sexual need and weren’t helped by estrogen remedy. She administers the hormone by pellets implanted beneath the pores and skin. Maclin mentioned this methodology produces only a few negative effects as a result of it employs pure (plant-based) testosterone relatively than the artificial methyltestosterone utilized in Estratest.
Of the 100-plus girls Maclin has handled with this methodology, solely two have been unable to tolerate the implant: “It precipitated irritation, and their our bodies expelled it.” The remainder, she mentioned, responded effectively and located themselves feeling sexual once more after a hiatus of months or years.
Whereas she considers the implants one of the best ways to ship testosterone, she is aware of of no different doctor who makes use of them. “I’m most likely in fairly a minority,” mentioned Maclin, who found the pellets when she took half in a examine about their use in girls. The pellets’ unique, and official, function is to offer testosterone to males who’ve a deficiency of testosterone, however Maclin administers them “off label”, which is the time period used when medication are prescribed for functions that haven’t been authorised by the FDA.
Adam Levine, MD, previously an teacher in reproductive endocrinology at Johns Hopkins College Faculty of Drugs and now a gynecologist in Tampa, FL, mentioned that thus far, he has prescribed male hormones to about 100 girls, with largely optimistic outcomes. Most of his sufferers have skilled an increase in libido on testosterone, with some additionally reporting “an elevated sense of well-being.”
For a number of years, Levine prescribed Estratest, which “labored pretty effectively” for libido, however precipitated negative effects in numerous sufferers.
So lately, he started providing “a more recent different,” DHEA. An androgenic hormone that’s produced within the adrenal glands of each sexes (and begins to say no earlier than age 30), DHEA is intently associated to testosterone. In actual fact, the physique has the flexibility to transform DHEA into different hormones, together with estrogen and testosterone. The hormone performs an vital function in intercourse drive. Taken as a complement, it additionally is alleged to bolster the immune system and delay the bodily indicators of getting old. However little is thought concerning the long-term results of taking DHEA.
As a result of it’s weaker than the testosterone utilized in Estratest, mentioned Levine, DHEA produces fewer negative effects however seems to be equally efficient in restoring libido. “The issue is that there are only a few sources that present pharmaceutical-grade DHEA,” mentioned Levine. “I do know of just one native pharmacy that gives it.” In any other case, the substance is accessible by way of vitamin and health-food shops, the place it’s tough to account for the standard.
Whereas Levine advocates using androgens to deal with flagging feminine intercourse drive, he acknowledges that “there’s not a whole lot of strong analysis on this space.” He nonetheless recommends that girls who bear libidinal modifications with menopause attempt estrogen remedy first.
Whereas there’s a dearth of complete scientific analysis — for example, the NIH has solely funded research on supplemental testosterone for males — a number of research on testosterone and girls’s libido have appeared in medical journals since 1995. Philip Sarrel, MD, a professor of ob-gyn and of psychiatry at Yale College and an lively researcher on this space, printed research in 1998 and 1999 concluding that testosterone-estrogen remedy is way simpler than estrogen alone in growing “sexual sensation and need” amongst postmenopausal girls.
Sarrel mentioned girls whose intercourse drive decreased with menopause (and didn’t reply to estrogen remedy), reported extra frequent intercourse, larger curiosity in intercourse and elevated clitoral sensitivity on testosterone. One examine famous that girls who acquired a mix of estrogen and testosterone additionally skilled much less melancholy and fatigue than these on estrogen alone.
The Way forward for Testosterone for Girls
FDA spokesperson Cruzan acknowledged that there’s most likely a “enormous off-label use of those medication.” However when requested to estimate what number of medical doctors are prescribing them for feminine sufferers nationwide, Cruzan conceded she has no thought. Certainly, given the unapproved standing of testosterone for girls within the U.S., it’s just about inconceivable to trace the variety of prescriptions disbursed particularly for this function.