My research shows how this can be done safely, conveniently, and with only occasional minor side effects.
In a recent interview in the New York Times (6/9/23), Emily Morse, host of the #1 Sexuality podcast on iTunes, Sex With Emily, described the “Five Pillars of Sexual IQ.” These are embodiment (meaning awareness of your self in your own body), health, collaboration (relating to and working with your sexual partners), self-knowledge and self-acceptance.
Women’s sexuality is extremely complex and quite different from that of men. Women’s sexual desire and function involves multiple parameters including sense of physical health, psychological safety, trust, privacy, and emotional sense of relationship wellness. All this comes first, then we have the effect of hormones on the mind and genitalia.
Testosterone levels drop in women as we age and more rapidly for women who have surgical removal of their ovaries. In women testosterone levels do not correlate with who has deficiencies and who does not. What we do know is that if testosterone levels are increased, from whatever the baseline is, there is improvement in multiple domaines of sexual function in women. Testosterone for women has been approved for women with low sex drive who are unhappy about this, HSDD. There are no approved testosterone preparations for women, so I needed to do research to determine how to replace testosterone in women safely and effectively.
Even if we give testosterone, the fact remains for us women, our brains are our greatest sexual organ. This means we have to be in a good mental state with ourselves and with our sexual partner to feel that intimacy is possible. It might be for some that a new desired partner rekindles sexual function and overrides any hormone deficiency.
However for women in long-term relationships who are not considering new partners, and experience decrease in desire, arousal, and pleasure, testosterone may help.
My testosterone research study was published in the Journal of The Endocrine Society in 2020. I used very low doses of testosterone 0.5-2 mg per day 6 days a week in post menopausal women with low libido. Levels were tested after 12 weeks of administration. The purpose was to see if I could achieve safe levels of testosterone with doses frequently used by compounding pharmacies. In my study the testosterone was compounded by only one pharmacy, so I did not have to deal with the possible inter-pharmacy variations. I have no financial involvement with this pharmacy, which was unaware of the research. After testing analysis of 4 modes of preparations: cream to the skin, cream to the vagina, vaginal suppository, or vaginal oil capsule, my research shows that 2 out of the 4 methods of administration of these tiny doses is pleasant and effective. One of the better methods is as a cream to the skin and the other is as a vaginal capsule in oil. Many of my patients were on bioidentical estradiol and progesterone (HRT). Some of my patients who could not use HRT or were older. These low doses and preparations significantly increased testosterone levels in women to healthy, upper normal, pre-menopausal testosterone levels. These low doses of testosterone also had little to no side effects for patients during the time of observation over 2 years. Rare side effects reported were 1 episode of acne and 1 with some hair growth. Both patients chose to stay on the testosterone but at lower doses. The lowest dose that achieves the goal for each patient is best. I also found that I could decrease the doses with time while still maintaining good blood levels of testosterone. Women on testosterone found that they had more energy and enjoyed sexual experiences better. The longest published studies on testosterone use in women have lasted 2 years.
My thoughts beyond my data are that low doses and gradual adjustments are the way to achieve health goals for now. While this research on nearly 50 women helps the journey of treatment for women, from looking at years of published research, it is my opinion that testosterone is additionally helpful in improving overall energy, bone mass and muscle mass in women. This may be particularly useful in older women who have osteoporosis and frailty, both of which increase risk of fractures, but also for early postmenopausal women who have osteopenia and low sex drive. It is also a helpful addition to HRT in women that are expecting to stay on HRT for the long run to maximally decrease mild but potential negative effect of long term estrogen exposure on breast tissue. There have been concerns that testosterone may have negative consequences on the heart. While the data is not out for women we now know that this is not a concern for men who need testosterone and receive replacement.
I thank my patients, my staff at Integrative Endocrinology and @Dr. Eric Olson MD for his support and editorial assistance with this article.
References:
Olson, Beatriz. Compounded testosterone preparations raise testosterone levels to premenopausal ranges in postmenopausal women with hypo-sexual desire disorder (HSDD). Journal of The Endocrine Society, Vol 4, Supple 1, April-May 2020.