Meeting Women's Desire for Desire

The Hormone of Desire

The 1990s saw several books about the benefits of testosterone for loss of sexual desire. "The Hormone of Desire" by Susan Rako (Harmony Books, 1994) decried the "patronizing, dismissive and irresponsibly uninformed" attitude of medical establishment toward the female sex drive.

Reichman created a stir when she appeared on Oprah Winfrey's television show with her book "I'm Too Young to Get Old: Health Care for Women Over Forty" (Times Books, 1996), and touted testosterone for increasing libido. Demand for the product spiked after that broadcast, according to compounding pharmacists.

That was nearly a decade ago. At the time, Reichman declared a "revolution" in testosterone use. But revolutions can be a long time in the making, and they seldom come without a battle.

Perceiving a potentially huge market, P&G developed Intrinsa, the first in a new class of drugs designed specifically for women's sexual problems. The product has been in clinical trials throughout the United States, Australia and Europe for more than six years.

Last December, the FDA denied approval of Intrinsa. Testimony from Tiefer and others persuaded an advisory panel that there were not enough long-term data to prove the product is safe.

In addition, Tiefer says, off-label use of Intrinsa was likely, meaning physicians would prescribe it in wider populations, such as pre-menopausal women and post-menopausal women who still had their ovaries. There are no studies of Intrinsa's safety in these women, Tiefer said.

Jan Shifren, director of the Vincent Menopause Program at Massachusetts General Hospital, is investigating the use of Intrinsa in women who have gone through natural menopause. All the women in Shifren's study expressed dissatisfaction with their sex lives. Her data show that the testosterone patch restored their desire. She presented this research at a meeting of the North American Menopause Society last year.

Both the women receiving testosterone and those receiving a placebo reported an increase in frequency of intercourse and sexual pleasure. Researchers can only speculate as to why this placebo effect occurred -- the desire of participants to have a better sex life, for example, or improved communication with their partners.

"We could never assume that this treatment would be suitable for everyone. If we see a pre-menopausal woman with low sexual desire, we treat the other causes first," says Shifren. "It's not a tablet you take an hour before you have sexual relations. It's a hormone designed for long-term use."

And that's precisely what bothers critics like Tiefer. "It was tested against a placebo for only six months," Tiefer said in a written statement. "This is grossly inadequate to evaluate long-term cardiovascular risk and rule out worries about breast cancer."

P&G issued a statement in December saying it hopes to work with the FDA to provide additional safety data. Until that time, many physicians like Berger-Weiss are comfortable prescribing compounded testosterone and combination testosterone-estrogen therapies.

Women Do Care

After more than six years of taking testosterone she obtains from a compounding pharmacy, Fran Way, 72, a retired nurse practitioner in Fort Meyers, Fla., feels better about her whole life. Not only did the testosterone cream she applies each day restore her desire for intimacy, she said, "for me, it even caused the return of sexual dreams and fantasies."

Way wishes more women were aware of testosterone. "We seem to think that women are just bored or dissatisfied with their relationships. I watch some of our friends who have been in relationships for a long time. There is no seductiveness. It seems they have just settled."

Simon has made a similar observation. "Some in our profession think that women don't care [about sex]. We would never say that about a man. Women do care more than we think. Women are entitled to a healthy sex life." ·

Freelance writer Lynn Crawford Cook last wrote for Health about parents who quit or rearrange their jobs to spend time at home with their teenage children. To respond to this article, send e-mail tohealth@washpost.com, or send a letter to the address on Page F2.