Testosterone therapy in women: Does it boost sex drive?

Q: Does testosterone therapy help increase sex drive in menopausal women? When should this be considered? What are the pros and cons?

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There's no consensus among doctors about the benefits and risks of testosterone therapy for menopausal women.

Testosterone is one of the hormones that contribute to healthy sexual function in women. Typically, however, testosterone therapy isn't recommended to improve low sex drive. For women, other factors are generally more important in determining sex drive — and much remains unknown about the effects of testosterone therapy in women.

Various factors associated with menopause and aging may contribute to changes in a woman's sexual desire and function. These include decreased estrogen levels, vaginal dryness, medication side effects, chronic health conditions, or the loss of a spouse or partner.

A woman's testosterone level gradually declines with age. Although natural menopause doesn't lead to an abrupt change in testosterone level, surgical menopause — which occurs after removal of the ovaries — can have this effect.

If a woman experiences reduced sex drive, depression and fatigue after removal of the ovaries, estrogen therapy may be recommended. If estrogen therapy isn't effective, low-dose testosterone therapy may be another option. Testosterone therapy may also be considered for postmenopausal women taking estrogen who have a decreased sex drive with no other identifiable causes.

In general, testosterone therapy is prescribed only for women who have sufficient estrogen levels. Typically, testosterone therapy isn't recommended for women who are postmenopausal and can't or choose not to take estrogen. Testosterone therapy isn't appropriate for postmenopausal women who have a history of breast or uterine cancer or those who have cardiovascular or liver disease.

For women, testosterone therapy can be given in the form of a cream or gel, and sometimes it's prescribed as a pill or injection. There have been no long-term studies of the risks and benefits of testosterone therapy in women. The most common side effects of testosterone therapy include acne and excess facial hair. Less common side effects include lowering of the voice, enlargement of the clitoris, liver problems, and mood or personality changes.

If you choose to try testosterone therapy, it's important to carefully monitor your symptoms and any side effects.

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