This post is written by Dr Karen Morton, Consultant Gynaecologist and Obstetrician and medical director to Dr Morton’s – the medical helpline, writing in response to a piece in the Daily Mail claiming that women get their sex drive back after taking testosterone. Dr Morton is MHM’s Medical Adviser.
Testosterone for libido isn’t for everyone, here’s why. Many women come to my gynaecology clinic to ask my advice about their dwindling sex-drive. They range in age, from teenagers to women in their 70s, but the commonest age group I see with libido problems is 40 to 60.
The Daily Mail raised this issue in an article about Kim Miller, 57, and her husband Adrian, 64, who had been married for 3 years at the time. Kim found that as she approached the menopause, her periods became sporadic and her previously high sex drive began to disappear. She felt she had lost the ability to enjoy sex, so she consulted a private gynaecologist, who found that she had low testosterone levels. She was given a testosterone gel and, later on, a testosterone pellet was implanted under her skin. She reported that the hormone treatment had an almost immediate effect on her level of arousal.
For me, the problem with this story is that it doesn’t apply to the vast majority of women. While it’s wonderful that Kim and her husband have found each other in later years, their relationship has not had to survive the stresses and strains of child rearing and being together for decades through thick and thin. Over the years, couples can experience physical changes in one or both parties, so it’s important to address sexual issues in a holistic manner.
So What About Testosterone For Libido?
Well, let’s just say there’s a reason that bald men still shave – facial hair growth and hair loss on the scalp are just two of the side effects of testosterone therapy. Other unhelpful side effects include acne, greasy skin, voice deepening, reduced breast size and fluid retention. The women over 50 out there who are like me will be familiar with the need to buy a reliable pair of tweezers and the horror when you realise you don’t have access to a mirror!
The truth is, if you are still having regular periods, this means your ovaries are functioning normally from a hormonal point of view. After the menopause, your ovaries stop making oestrogen and this makes the vaginal and the vulval tissues undernourished, dry and sore. This can make sex extremely painful, and – as I say to the women who come to see me – if it hurts, why would you want to do it?
This problem can usually be easily remedied by nourishing the vagina with oestrogen, using either a cream or a pessary (a tablet inserted into the vagina). It takes about three months for the full benefits to kick in, by which time the vaginal lining will have grown pink and plump, from its deepest tissues to the very top layer. That is how long it takes for skin to go through the full growth cycle – it’s the reason we lose a suntan in three months.
Obviously this solution involves only the vaginal area. Women experiencing a range of menopausal symptoms may choose to take hormone replacement therapy (HRT), either by taking tablets or applying a skin patch. This means the oestrogen is released into the bloodstream, but it still nourishes the vagina in the same way that the creams and pessaries do, as well as doing all the other things that HRT is intended for, such as preventing bone thinning and treating hot flushes.
For the women who come to me tell me that sex isn’t hurting, I usually go on to say that sex drive is a very multifactorial thing. I put them through what I call the George Clooney Test: imagine your celebrity crush – that popstar who makes your heart melt when they sing, that actor who gives you butterflies whenever you see a photo in a magazine. (For me, it’s George Clooney. It used to be Piers Brosnan, but I’m afraid his attempt at singing in Mamma Mia forced me to re-evaluate.)
If that person appeared before you right now, preferably wearing a slick evening number and carrying a bunch of red roses, and took you out to a lovely restaurant, wined and dined you, and then swept you off your feet on the dance floor, would that get your drives and juices going? If it would then there is nothing wrong with you.
I don’t mean to make light of these things, and indeed I am not. I am simply acknowledging the realities of life. Sometimes libido is an intangible thing – a magical phenomenon that we don’t always understand.
When it comes to improving sex, there will always be wonder drugs and celebrity endorsements of new therapies, but I personally wouldn’t risk suffering the many side effects of testosterone therapy for a potentially limited benefit. If you’re experiencing issues with sex, my advice is to speak to a doctor – especially if it’s painful or if there’s bleeding, as this can be caused by non-hormonal problems that may be serious and need a proper assessment.
More posts by Karen Morton – Dr Morton’s – the Medical Helpline