Imagine forty million women standing in a field (nice dream, huh, you men out there who stumbled in here by accident?). If you’re having trouble getting your brain around a number that large, imagine all those old film clips of the crowds at Woodstock back in 1969. Now take that picture and multiply it by 80. Whoa – big field. Now imagine every one of those women has a problem with low sexual desire. Think that could never happen? Think again, because that’s the current number of women in the United States alone who claim they have lost their normal and healthy interest in sex (sorry to ruin the picture for you, guys, but it’s true). “What’s happening,” you must be thinking – unless, of course, you’re one of those women. Then you’re probably thinking, “Thank god, I’m not alone!”

While diminished sex drive has a wide variety of causes and can be attributed to many things, this article will focus on only one. What I’m about to share with you is not meant to imply that the solution to low or no sexual desire is easy to fix. Or that there is only one approach or one solution. A low sex drive or complete lack of sexual desire can be attributed to a plethora of reasons – everything from simple exhaustion due to the complex lives that most women lead these days, to lack of an appropriate sexual partner, to marital or long-term relationships that have gotten stale, to such serious problems as physical illnesses like depression and cancer. The scope of the issue is much too broad for me to address in its entirety here, but I would like to talk about a seldom mentioned cause – decreased testosterone levels in women that occur most often during perimenopause and menopause (for an introduction to the topic of perimenopause, please see the Archive for my recent editorial).

Testosterone and women, you might ask? Yes, we’re all led to believe that testosterone is the male hormone and that, as women, it really doesn’t affect us. Current research has uncovered the myths behind this notion. The female body produces significant amounts of testosterone and this hormone is responsible for the healthy functioning of libido in both men and women. And just so you don’t get the mistaken impression that testosterone is only implicated in matters sexual, please let me assure you that testosterone is important for other areas of the body as well. The health of brain, bones, and heart is also dependent on proper levels of testosterone. This androgen is also responsible for a general sense of well-being. We are just beginning to learn how far reaching the effects of this particular hormone are. Lowered sexual desire is just one symptom (and often the most obvious) of diminished testosterone levels.

Research has proven the following (taken from the book, The Hormone of Desire, by Susan Rako, M.D.):

Fact #1
"A woman’s normal physiology includes the production of a critical amount of testosterone, essential to her normal sexual development, to the healthy functioning of virtually all tissues in her body, and to her experience of vital energy and sexual libido."

Fact #2
"This critical amount of testosterone decreases after menopause in many women, resulting in a loss of vital energy and libido."

Fact #3
"Supplementary testosterone can be a substantial help in restoring a woman to her familiar level of energy, libido, and well-being."

Fact #4
"Only the use of irresponsibly high doses of testosterone over a sustained period of time can produce undesirable effects."

While many women are relatively familiar with the topic of traditional hormone replacement therapy (HRT – or supplementation with some kind of combination of estrogen and/or progesterone) during and after menopause, it is striking how few women are aware that their testosterone levels may also be inadequate. What is even more appalling is the lack of education among physicians regarding this issue. And it is sad to contemplate that so many women are offered (or even pressured) into taking antidepressants when the problems for some of them could be attributed solely to fluctuating hormone levels (testosterone being one that many physicians don’t even consider). Again, I would like to stress that supplementation with testosterone is not a magic bullet. If a woman’s problems are not attributable to this, supplementation will offer her no relief. However, it is my belief that a significant portion of women complaining about lowered sexual response should look to testosterone first as the culprit. It is relatively easy to determine within the first few weeks or months of treatment whether this is the cause or not.

Testosterone deficiency is not merely a sexual issue. It is a quality-of-life issue. This hormone brings a healthy glow to your skin and a shine to your hair. Androgens have some biological activity on nearly every tissue in the body – this translates into keeping the cells of the body functioning efficiently, providing nourishment for proper growth and maintenance, as well as contributing to the health of bone and muscle. Inadequate testosterone can lead to what physiologists describe as a “catabolic state” – one in which the body experiences loss of muscle tone and what the brain perceives as loss of vital energy and a sense of well-being. Yes, the amount of testosterone required by women is tiny, but that miniscule amount is crucial. And just in case you are worried that testosterone supplementation will make you more manly, the amounts used are very, very small. Masculinizing effects (lowered voice, increased body hair, etc.) are not seen at the doses prescribed for most women and should not be a concern.

As I warned in the beginning of this discussion, it is not my intent to make you aware of all the vital information about this topic. Space and time limitations prevent me from doing so. I simply wanted to bring this issue to the forefront so you would begin to think about it and investigate it further as it applies to you. And here is where I will turn you over to the experts. In addition to the HotFlash! site I recommended in my prior editorial on perimenopause, I would like to recommend two excellent books on this subject. They are:

The Hormone of Desire:
The Truth about Testosterone, Sexuality and Menopause
By Susan Rako, M.D.

I’m Not in the Mood:
What Every Woman Should Know About Improving Her Libido
By Judith Reichman, M.D.

The first deals specifically with testosterone and its implications in women’s health, while the second book discusses the subject in broader terms and outlines all the saboteurs to women’s sexual lives (including psychological issues, couple trouble, medications, diseases, surgery/chemotherapy/radiation, pain, and finally men). These books read in conjunction with one another should provide all the answers you have been looking for and more information than I could possibly offer in a short editorial. If nothing else, they should make you feel much better and more well-armed if this has been a problem for you that you have been reticent to discuss with anyone. Clicking on the titles of these books will take you to places where they can be purchased.

Every woman has the right to a long and satisfying sexual life, and to a healthy life in general. And along with rights come responsibilities – the responsibility to ask questions, the responsibility to demand answers. There are many treatment options available and all women should discuss this topic with their gynecologists and/or primary care physicians (believe me, ladies – most will not broach the topic with you, so you have to be proactive). Please read the two books I have recommended before you visit your doctor as you may find him/her less than well-versed in this subject. It is up to us as healthcare consumers to learn and research and demand information. As always, I wish you success on this journey. It’s a most important one for your physical well-being and your mental and emotional health. Please do not allow embarrassment or fear to restrict you from living the fullest life you can. These things are your due as a human being. Let your voice be heard!

Author’s Note: My thanks to the authors of the books I mentioned where I found most of the information for this editorial.

Disclaimer: The information provided in this editorial is for informational purposes only and the author cannot make guarantees of accuracy or application of the information to any specific individual. Diagnoses and treatments should be obtained and/or recommended only by a qualified healthcare practitioner. All women are encouraged to speak to their doctors first before making any significant changes to their healthcare regimen.