Desire for Desire; Testosterone Fix Risky, Say Some Experts" by Lynn
Here's the article:
If you could follow gynecologist Jessica Berger-Weiss around in her
Spring office for a day, you might be surprised by what you hear. Four
five times a day, every day, women in their thirties, forties and
emotionally tell Berger-Weiss about a problem they think is uniquely
"Doctor, I just don't have any interest in sex."
Women in midlife are inundated with emotional and physical reasons why
can't experience a fulfilling sex life. Who hasn't heard the jokes
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
of sex drive is unfortunate, it is common -- almost universal," said
Goldstein, co-director of the Sexual Wellness Center in Annapolis.
"Libido is very important for a relationship," said Goldstein. "If a
has no desire, the responsibility [for initiating sex] always falls to
partner. Of course, partners become very unhappy. They take it
They feel rejected."
Although many factors contribute to low sexual desire in women,
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
in this case the area associated with sexual desire. Usually thought of
male hormone, testosterone is produced by women as well, albeit in
amounts, beginning at puberty. Women produce testosterone primarily in
ovaries with a small amount produced by the adrenal glands. Between the
of 30 and 50, a woman's ovaries gradually shut down in the process
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
area offer testosterone therapy to women seeking to improve their sex
Although the Food and Drug Administration (FDA) has not approved a
testosterone-only product for women, citing the lack of long-term
data, some physicians prescribe methyltestosterone, an
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
testosterone level of someone much younger?
"It's not natural for it [testosterone] to be there [after a certain
said James Simon, a clinical professor at George Washington University
Medical School. However, he said, "only in the last 100 years have
lived long enough to need hormone therapy. In every other species,
die when their reproductive ability goes away. Historically, we don't
what 'normal' is," said Simon, who is also involved in the P&G
A Fact of Life?
Low libido is the most common sexual disorder in women, according to
1994 National Health and Social Life Survey, in which one in three
respondents said they were uninterested in sex. Hypoactive sexual
disorder (HSDD) -- defined as "persistently or recurrently deficient
absent) sexual fantasies and desire for sexual activity" -- has been
in the American Psychiatric Association's Diagnostic and Statistical
of Mental Disorders (DSM) since 1987.
"Women are raising the issue with their physicians as frequently if not
so than men," according to Berger-Weiss.
Numerous studies over the past 20 years have established the
value of testosterone for restoring women's libido. A review of the
published in the journal Menopause last year concluded that "certain
of testosterone therapy were associated with higher frequency of sexual
activity . . . desire, thoughts and fantasies, arousal, responsiveness,
In 2000, the New England Journal of Medicine published the results of
of the first studies of the P&G patch, which showed that testosterone
markedly improved sexual function in women whose ovaries had been
removed. In the past year, several more published studies have shown
significant improvement in the libidos of surgically menopausal women
used the patch. So far, there have been no published studies of women
have gone through menopause naturally, although P&G is funding research
Last year, the journal published an article showing the patch prompted
substantial improvement in low-libido women who had gone through
menopause. Most recently, Intrinsa was found to slightly improve sexual
function in pre-menopausal women, as published in the journal
Hormones play a critical role in all aspects of reproductive health,
according to Judith Reichman, "Today" show medical correspondent and
of "I'm Not in the Mood" (William Morrow & Co., 1998). Women need
estrogen for lubrication and comfort during sex. But they need
to feel desire in the first place. With diminished testosterone,
said, women don't just lose desire for their partners, they lose desire
Some women's health advocates oppose the use of pharmaceuticals to
sex drive. According to Leonore Tiefer, associate professor at New York
University Medical School, "There are no norms in terms of sexual
nor could there ever be any." Treating lack of libido with a drug
lack of attention to real sexual problems and their sources. Just
chemical produces a response is no reason to think the situation prior
medical condition," she says.
What's the Problem?
For some women, lack of desire is not a problem. Like the late writer
S. Thompson, they are glad to finally dismount the "wild stallion"
been riding most of their adult lives and settle down to other
many who no longer enjoy sexual satisfaction miss it -- a lot.
Jean Atkins, 53, of suburban Maryland, said she lost interest in sex
completely after a hysterectomy and removal of her ovaries three years
Until that time, sexual desire was a normal part of her life. After the
surgery, she said, "it was the furthest thing from my mind."
Atkins mourned the loss of what had been an important part of her
relationship with her husband. "He was very understanding," she said.
we were both just kind of disappointed." When a friend told her that
testosterone patch was being tested in a clinical trial, Atkins jumped
the chance to enroll in it.
Now she is welcoming sex back into her life.
"I notice a difference. I think about sex more than I have in years,"
said. After completing her part in the study, she learned that she had
received Intrinsa, not the placebo against which it was being compared.
Although she experienced some of the common side effects of
such as an extra facial hair or two, she plans to continue taking
How Much Is Enough?
Blood testosterone levels in women have not been shown to correspond
libido. According to Simon, "In men there is a correspondence -- the
testosterone, the more erections and sexual thoughts." But while men
more creatures of their hormones, said Simon, "women are very complex"
their sexual responses.
Further confounding the issue is that measurements of testosterone are
reliable in women. Because women produce so little of the hormone,
testosterone tests, which were developed for men, are not sensitive
to provide an accurate measurement.
In a study published in the July 6 issue of the Journal of the American
Medical Association, researchers in Australia (one of whom receives
from P&G) found no association between low libido and low blood
levels. They wrote, "The measurement of serum testosterone . . . in
individuals with low sexual function is not informative and levels of
hormones should not be used for the purpose of diagnosing
insufficiency in women."
In other words, said Simon, with female sexual function, "Treat the
not the blood test."
The Hormone of Desire
The 1990s saw several books about the benefits of testosterone for loss
sexual desire. "The Hormone of Desire" by Susan Rako (Harmony Books,
decried the "patronizing, dismissive and irresponsibly uninformed"
of medical establishment toward the female sex drive.
Reichman created a stir when she appeared on Oprah Winfrey's television
with her book "I'm Too Young to Get Old: Health Care for Women Over
(Times Books, 1996), and touted testosterone for increasing libido.
for the product spiked after that broadcast, according to compounding
That was nearly a decade ago. At the time, Reichman declared a
in testosterone use. But revolutions can be a long time in the making,
they seldom come without a battle.
Perceiving a potentially huge market, P&G developed Intrinsa, the first
new class of drugs designed specifically for women's sexual problems.
product has been in clinical trials throughout the United States,
and Europe for more than six years.
Last December, the FDA denied approval of Intrinsa. Testimony from
and others persuaded an advisory panel that there were not enough
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
women and post-menopausal women who still had their ovaries. There are
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
gone through natural menopause. All the women in Shifren's study
dissatisfaction with their sex lives. Her data show that the
patch restored their desire. She presented this research at a meeting
North American Menopause Society last year.
Both the women receiving testosterone and those receiving a placebo
an increase in frequency of intercourse and sexual pleasure.
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
If we see a pre-menopausal woman with low sexual desire, we treat the
causes first," says Shifren. "It's not a tablet you take an hour before
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
"This is grossly inadequate to evaluate long-term cardiovascular risk
rule out worries about breast cancer."
P&G issued a statement in December saying it hopes to work with the FDA
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
Meyers, Fla., feels better about her whole life. Not only did the
testosterone cream she applies each day restore her desire for
said, "for me, it even caused the return of sexual dreams and
Way wishes more women were aware of testosterone. "We seem to think
women are just bored or dissatisfied with their relationships. I watch
of our friends who have been in relationships for a long time. There is
seductiveness. It seems they have just settled."
Simon has made a similar observation. "Some in our profession think
women don't care [about sex]. We would never say that about a man.
care more than we think. Women are entitled to a healthy sex life." ?