In February 1999, researchers published a report in the Journal of the American Medical Association entitled “Sexual Dysfunction in the United States.” Using data from the National Health and Social Life Survey, a study of adult sexual behavior in the United States, they calculated the incidence of various sexual problems among adults aged 18–59. Among the women in this representative sample, the number one problem was low libido, which affected almost one-third of survey respondents.
Why are so many women uninterested in sex? There are many possible reasons, both physical and psychological. In my experience as a physician who has treated thousands of women over the years, one underappreciated explanation for a woman’s loss of interest in sex is inattention by her husband or male companion—both in the bedroom and outside of it. A man who consistently performs intercourse to achieve his own pleasure, without giving attention to his wife’s feelings, will usually find a passive, disinterested sexual partner.
Women are more responsive to men who understand that lovemaking is an ongoing experience of affection. A woman who is not listened to, appreciated, or gratified sexually by her husband or male companion is unlikely to be romantically inclined.
However, there is another reason why women may experience a decline in libido, especially as they pass into their thirties, forties, and beyond: a deficiency of testosterone.
If you’re wondering what testosterone has to do with a woman’s interest in sex, the answer is: everything. In women as well as men, testosterone is the hormone of desire. The millions of women in this country who experience estrogen dominance suffer not only from a relative deficiency of progesterone but also from a deficiency of testosterone.
In women who are of reproductive age, levels of testosterone peak at ovulation, the very time in a woman’s menstrual cycle when she is fertile. This surge in testosterone midway through her cycle stimulates a woman’s desire for sex. However, when a woman is estrogen dominant, she experiences numerous anovulatory cycles in which there is no elevation in testosterone at this midpoint. This problem is compounded by the fact that estrogen dominance increases the liver’s production of sex hormone–binding globulins, proteins that attach to the small amount of testosterone in circulation and inhibit the hormone’s entry into cells.
Signs and Symptoms of Low Testosterone in Women:
Depression and/or anxiety
Low blood levels of free testosterone, If estrogen dominance is bad news for a woman’s libido, a hysterectomy can be devastating. About half of a woman’s testosterone is produced by her ovaries, with the other half produced in the adrenal glands. Women who undergo a total hysterectomy, with the removal of their ovaries, immediately lose 50 percent of their circulating testosterone. The resulting symptoms of low libido, fatigue, and malaise often are attributed wrongly to the sharp drop in estrogen, when in fact it is the abrupt decline in testosterone levels that is the culprit. The primary sexual effect of estrogen deficiency is thinning and dryness of the vaginal tissues, not a decrease in desire. For women who undergo natural menopause, the decline in testosterone is more gradual, but it still can dampen libido and contribute to depression, anxiety, and other psychological symptoms.
The solution is obvious: supplementation with small, physiologic replacement doses of natural testosterone to restore levels to those of a healthy young woman. Sadly, this option is rarely offered to women by conventional physicians.
As with estrogen and progesterone, the form of testosterone that I recommend for women is time-released micronized capsules. Micronized hormones are 80–90 percent absorbed, and the time-release base allows for the slow, steady absorption of testosterone in the small intestines and the lymphatic system. The dose is adjusted as necessary according
to a woman’s symptoms and periodic measurements of free testosterone levels in the blood, if indicated.
Besides its beneficial effects on female sexual desire and pleasure, testosterone improves the tone of the vagina and bladder, decreases body fat, improves muscle strength and bone density, enhances the function of thyroid hormone, relieves anxiety and depression, and promotes clearer thinking.