Meeting Women's Desire for Desire

Testosterone Fix Risky, Say Some Experts

If you could follow gynecologist Jessica Berger-Weiss around in her Silver Spring office for a day, you might be surprised by what you hear. Four to five times a day, every day, women in their thirties, forties and fifties emotionally tell Berger-Weiss about a problem they think is uniquely theirs: "Doctor, I just don't have any interest in sex."

Women in midlife are inundated with emotional and physical reasons why they can't experience a fulfilling sex life. Who hasn't heard the jokes about couples saying so long to sex once they have children? Add in typical midlife events such as stress, illness, depression, medications, relationship problems and plain old boredom, and it's no wonder some middle-aged women have little interest in intimate relations. "Though loss of sex drive is unfortunate, it is common -- almost universal," said Andrew Goldstein, co-director of the Sexual Wellness Center in Annapolis.

"Libido is very important for a relationship," said Goldstein. "If a woman has no desire, the responsibility [for initiating sex] always falls to her partner. Of course, partners become very unhappy. They take it personally. They feel rejected."

Although many factors contribute to low sexual desire in women, Goldstein said that for some there is an underlying biological mechanism at work. Goldstein is an investigator in a study of Intrinsa, a Procter & Gamble (P&G) testosterone patch that the company hopes will provide a medical solution for women's diminished desire. He and many of his colleagues believe that testosterone can restore sex drive in some women.

Like all hormones, testosterone works by stimulating an area of the brain, in this case the area associated with sexual desire. Usually thought of as a male hormone, testosterone is produced by women as well, albeit in small amounts, beginning at puberty. Women produce testosterone primarily in their ovaries with a small amount produced by the adrenal glands. Between the ages of 30 and 50, a woman's ovaries gradually shut down in the process leading up to menopause. By the time a woman is 40, her testosterone level has declined by up to 50 percent. After menopause, it drops even further.

Goldstein, Berger-Weiss and dozens of other physicians in the Washington area offer testosterone therapy to women seeking to improve their sex lives. Although the Food and Drug Administration (FDA) has not approved a testosterone-only product for women, citing the lack of long-term safety data, some physicians prescribe methyltestosterone, an estrogen-testosterone combination designed to treat symptoms of menopause. Some, like Berger-Weiss, refer patients to compounding pharmacies, which make customized testosterone products.

But is it normal, or even desirable, for a middle-aged woman to have the testosterone level of someone much younger?

"It's not natural for it [testosterone] to be there [after a certain age]," said James Simon, a clinical professor at George Washington University Medical School. However, he said, "only in the last 100 years have women lived long enough to need hormone therapy. In every other species, females die when their reproductive ability goes away. Historically, we don't know what 'normal' is," said Simon, who is also involved in the P&G research.

A Fact of Life?

Low libido is the most common sexual disorder in women, according to the 1994 National Health and Social Life Survey, in which one in three female respondents said they were uninterested in sex. Hypoactive sexual desire disorder (HSDD) -- defined as "persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity" -- has been listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) since 1987.

"Women are raising the issue with their physicians as frequently if not more so than men," according to Berger-Weiss.

Numerous studies over the past 20 years have established the therapeutic value of testosterone for restoring women's libido. A review of the research published in the journal Menopause last year concluded that "certain types of testosterone therapy were associated with higher frequency of sexual activity . . . desire, thoughts and fantasies, arousal, responsiveness, and pleasure."

In 2000, the New England Journal of Medicine published the results of some of the first studies of the P&G patch, which showed that testosterone markedly improved sexual function in women whose ovaries had been surgically removed. In the past year, several more published studies have shown significant improvement in the libidos of surgically menopausal women who used the patch. So far, there have been no published studies of women who have gone through menopause naturally, although P&G is funding research on that group.