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Women’s Health

August 18, 2022

Women’s Health

Talk to your doctor about helping you address the true cause of your low sex drive.

For women seeking treatment for low sex drive, the idea of a “quick fix” probably sounds appealing. Testosterone therapy and boosting supplements are among those widely marketed options that might seem too good to be true – because for most women, they are.

Low testosterone (low-T) products for women such as pills, injections, or supplements like dehydroepiandrosterone (DHEA) claim to boost energy, mood, and sexual desire. However, low-T as the root cause for low sex drive is rare in women, especially before menopause.

The Endocrine Society stated in 2019 that while trying testosterone therapy is generally safe for post-menopausal women with hypoactive sexual desire disorder (HSDD) – not wanting sex and not being OK with feeling that way – they do not support low-T therapy for other female health conditions. Side effects from testosterone therapy in women can include:

• Deepening of voice
• Enlargement of clitoris
• Excessive body hair
• Increased acne
• Abnormal fetal development during pregnancy

One in three women struggle with low sexual desire, and most patients start noticing libido changes after menopause. However, low libido can occur at any age and is often caused by problems that aren’t directly linked with the bedroom, such as anxiety, stress, medications, or undiagnosed chronic conditions.

While low-T treatments aren’t the cure-all they claim to be, there are effective treatments to restore sexual desire and improve your quality of life. UT Southwestern’s Reproductive Endocrinology and Infertility specialists follow a three-step process to identify and address the root cause of low libido.

The first step is to pinpoint the source – or sources – of sexual frustration. From there we can design a personalized treatment plan that can help improve overall health along with libido.

For treatment to be effective, we must first try to understand what is affecting your sex drive. There is no cookie-cutter approach – in our three-step program, every patient gets a personalized assessment and treatment plan tailored to her specific needs.

1. General mental and physical health assessment

Working with a team of specialists, your reproductive health doctor will help identify or rule out underlying conditions and medical treatments that are known to decrease libido.

For example, anxiety can significantly affect the desire for sex – women are approximately twice as likely as men to suffer from anxiety before age 50. And women are more likely to report physical symptoms of stress that can interfere with sex drive, such as headache or upset stomach.

Physical health conditions can intertwine with mental health symptoms to double down on your sex drive:

• Heart problems: Along with reduced stamina, having heart problems can induce anxiety about getting your heart rate up during intimacy.
• Incontinence: Leakage can make you feel insecure about your appearance or odor, causing sexual avoidance.
• Diabetes: Blood sugar highs and lows can diminish energy you might have reserved for intimacy.
• Cancer: Systemic treatments for cancer can cause fatigue, nausea, and other symptoms that don’t put you in the mood.
• HSDD: This multifactorial condition is typically diagnosed in women after menopause. It can be caused by a combination of emotional and physical health concerns and is characterized by feeling poorly about not desiring sex.
• Multiple sclerosis: Arousal starts in the nervous system, which is the primary target of this disease. Medications to treat it can also diminish desire.
• Pelvic floor disorder: This condition causes weak muscles in the pelvic area, which can cause uncomfortable or painful sex.
• Thyroid disease: Hormones made by the thyroid help manage many of our body processes, including some aspects of libido, such as energy and stamina.

Common medications such as antidepressants, blood pressure medication, and estrogen therapy also can reduce libido. Your reproductive health doctor can order specific tests and exams to start unraveling the root causes of your symptoms.

Often, patients with physical or medication-related concerns begin feeling desire again after starting or modifying their care plan. Post-menopausal patients may particularly benefit from specialized care for hormone- and aging-related changes that interfere with intimacy, such as vaginal dryness, changes in appearance, or emotional challenges.

Mental health concerns sometimes require a little more time and patience to start feeling results. Seeing a therapist who specializes in sexuality can help women discover underlying barriers and gain more control over their libido.

Related reading: What women need to know about thyroid disorders

2. Visits with a sex specialist

Personal experiences can stack up over time, leading to diminished sex drive and discomfort with intimacy. Talking with a sex therapist gives patients a safe space to discuss past trauma, current difficulties, and relationship issues without judgment. A therapist can help you understand why these situations are decreasing your libido and help you find healthy pathways to start feeling better.

Psychosexual counseling is another avenue that can help women and their partners understand how the mind and body interplay with regards to intimacy. In these sessions, the therapist works with the patient or couple to express their feelings, discuss medical concerns that are interfering with sex, and find workable solutions to satisfy their personal and relationship goals.

3. Discussing treatment options

Your treatment plan will be based on your needs and the results of your assessments. Most patients will see positive results from getting treatment for the specific condition causing their symptoms. Some need a more tailored approach, such as adjusting mental health medications or participating in longer-term counseling sessions before desire returns.

For most women, testosterone therapy will not be a recommended treatment option. Testosterone has not been widely approved by the U.S. Food and Drug Administration for premenopausal low libido, and no large clinical studies have included younger women.

Though some post-menopausal patients with HSDD may experience slight benefits from testosterone therapy, particularly if they still have reduced sex drive after taking estrogen, the benefits probably won’t outweigh the risks. There is very little long-term safety data on testosterone therapy in women.

Patients who want to try off-label testosterone therapy should do their research and consider the potential risks related to appearance and long-term health, including:

• Pregnancy risks: Avoid testosterone if you are or want to become pregnant. Testosterone can cross the placenta and cause abnormal fetal development.
• Increased risk of Type 2 diabetes: A study of more than 8,800 women showed that those who took testosterone and testosterone-associated supplements were at increased risk of developing the disease. Weight changes and fat redistribution during menopause can increase insulin resistance, which is a factor in Type 2 diabetes – adding testosterone therapy might further increase the risk.
• Missed diagnosis of underlying conditions: Symptoms that go along with low libido crossover with many serious health problems, such as thyroid disease or diabetes. Without proper diagnosis and treatment, these conditions can cause life-threatening heart complications.

Getting effective treatment for a decreased sex drive before or after menopause can improve your mental and physical health. While testosterone might not be the answer, help is available.

Don’t be afraid to talk with a doctor about the symptoms of decreased sex drive. We’ll address the problem at its source and start you on the path to feeling better.

To talk with an expert at our Women’s Center, call 214-645-3888 or request an appointment online.

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More Articles

Safety of testosterone use in women

Review

. 2009 May 20;63(1):63-6.

doi: 10.1016/j.maturitas.2009.01.012.

Epub 2009 Feb 27.

Chrisandra L Shufelt 
¹
, Glenn D Braunstein

Affiliations

Affiliation

• ¹ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

• PMID:

  19250779

• DOI:

  10. 1016/j.maturitas.2009.01.012

Review

Chrisandra L Shufelt et al.

Maturitas.

2009.

. 2009 May 20;63(1):63-6.

doi: 10.1016/j.maturitas.2009.01.012.

Epub 2009 Feb 27.

Authors

Chrisandra L Shufelt 
¹
, Glenn D Braunstein

Affiliation

• ¹ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

• PMID:

  19250779

• DOI:

  10.1016/j.maturitas.2009. 01.012

Abstract

Female sexual desire appears to be in part androgen dependent, which has lead to the use of testosterone in women for low libido. Despite this benefit, the long-term safety of testosterone as a hormone replacement or therapy has not been well established. Side effects of testosterone therapy include mild and reversible acne and hirsuitism, as well as changes to the lipid profile with oral, but not transdermal testosterone. Short-term studies, up to 2 years, have shown that for serum plasma testosterone levels at the upper portion or slightly above the reference range for reproductive-aged women, testosterone does not increase the risk of hepatotoxicity, endometrial hyperplasia, or behavioral hostility. No adverse cardiovascular effects including changes in blood pressure, blood viscosity, arterial vascular reactivity, hypercoagulable states, and polycythemia have been shown. Data is mixed with outcomes of breast cancer risk, with some experimental studies suggesting a decrease in estrogen-induced breast epithelial proliferation with low dose testosterone. Additionally, models of superphysiologic testosterone levels, such as polycystic ovarian disease, have not shown an increased risk of breast cancer. As with all hormone therapy in postmenopausal women, testosterone therapy should be individualized and requires that each woman weigh the risk and benefits. Nevertheless, only long-term safety studies will provide conclusive evidence as to testosterone safety in women.

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Publication types

MeSH terms

Substances

Harm from the use of testosterone and anabolic steroids

Published on 19.3.2010.

Testosterone is the body’s own male sex hormone. Anabolic steroids are its synthetic derivatives. The use of these doping drugs is only permitted for the treatment of diseases, e.g. osteoporosis. It is estimated that there are between 5,000 and 10,000 abusers of testosterone and anabolic steroids in Finland. They use these drugs periodically, primarily to acquire a muscular figure. Abuse causes a violation of hormonal functions and can lead to many serious diseases and mental disorders. Consumption increases risks such as infertility, cardiovascular disease, liver damage and depression.

Medical use

Both testosterone and anabolic steroids, according to the regulation (705/2002) paragraph 1 paragraph 16 chapter 44 of the Criminal Code, are classified as doping drugs. They are available by prescription and are approved for use only for the treatment of diseases approved by the pharmaceutical authorities.

Such diseases are, in particular, underproduction of testosterone in the pituitary gland or testicles, various anemias, osteoporosis, as well as chronic diseases in which protein loss and delayed tissue regeneration occur. Testosterone is also used to treat menopausal symptoms in men.

Testosterone is administered as an injection containing various testosterone esters (eg testosterone propionate, testosterone enanthate, testosterone phenylpropionate, testosterone isocarbonate, testosterone decanoate, testosterone undecanoate) or as oral testosterone undecanoate capsules. Anabolic steroids are available as injections and tablets.

Abuse

There are 5-10 thousand abusers of testosterone and anabolic steroids in Finland. They are usually men aged 20-35 years. The main purpose of the use is to create a muscular figure. On the other hand, the use of steroids tends to raise their status, for example, in a team of athletes. Among weightlifters, the motive is to improve athletic performance.

Abuse of anabolic steroids is characterized by their intermittent use. Cycles of use last from several weeks to several months, between which there are breaks of several months. At the beginning of the cycle of use, the amount of steroids increases gradually. At the end of the cycle, the use is stopped stepwise for 1-2 weeks. For abuse, the typical pattern is the use of increased doses.

Harmful effects: hormonal disorders

When testosterone or anabolic steroids are ingested in excess of normal requirements, they cause hormonal disorders.

In men, harmful effects are seen in the form of a weakening of the production of hormones by one’s own body. Structural atrophy occurs in the glands and organs that produce hormones, such as the testicles. After the hormonal cycle, infertility and withering of sexual functions follow.

Women who use testosterone and anabolic steroids experience hairiness, deepening of the voice, breast reduction, hair loss, clitoral hypertrophy, skin problems, and menstrual irregularities. After cessation of use, some of these influences remain constant.

Younger consumers may experience stunting resulting in short stature.

Harmful influences: serious illnesses

When overdosed, testosterone and anabolic steroids disrupt lipid metabolism in a direction unfavorable to health. The constant use of these hormones increases the risk of diseases of the cardiovascular system, as well as the risk of heart attack and stroke. Steroids weaken the force of contractions of the heart and cause myocardial dystrophy, increasing the likelihood of arrhythmia and sudden death.

In addition, the use of these hormones increases the risk of diabetes mellitus, and their administration with shared syringes increases the likelihood of contracting blood-borne infections, incl. jaundice (hepatitis) and HIV.

Excessive use of testosterone and anabolic steroids also increases the risk of cancer and liver damage. Anabolic steroids taken by mouth in tablet form are more harmful to the liver than anabolic steroids in the form of injections. Liver disease ranges from mild transient cell damage and jaundice to malignant liver tumors with a poor prognosis even when cured.

Harmful effects: mood disorders

Testosterone and anabolic steroids also act on the central nervous system. Their sites of action in the brain are connected to centers that regulate mood, sexuality, and aggressiveness.

Among individuals using increased doses of testosterone and anabolic steroids, 20-30% during the steroid cycle have mood disorders that meet the criteria for psychiatric illness, such as depression, depression, psychotic reactions with hallucinations, hypomania, and impaired cognitive functioning.

In 30% of people who use increased doses of anabolic steroids, aggressiveness, hostility and irritability are observed during use. Based on several reported cases, it can be said that hormones weaken impulse control. The medical literature describes cases in which previously mentally balanced individuals, after the start of hormone use, became prone to violent behavior and committed unintentional homicide.

According to a study conducted among the Finnish population, the risk of death among anabolic steroid and testosterone abusers is 4. 6 times higher than in the control group.

Timo Seppälä
Medical Director
Finnish Anti-Doping Commission
(Suomen Antidopingtoimikunta ADT ry)

https://dopinglinkki.fi/en/glavnaya

Sources:

Pirkola & Seppälä (2005): Huumeet ja anaboliset aineet. Nuorten terveys 2000. Kansanterveyslaitoksen julkaisuja, KTL B7/2005, 65–68.

Bahrke & Yesalis (2004): Abuse of anabolic androgenic steroids and related substances in sport and exercise. Current Opinion in Pharmacology 4: 614–620.

Hall & Hall (2005): Abuse of Supraphysiologic Doses of Anabolic Steroids. Southern Medical Journal 98: 550–555.

Seppälä & Karila (1996): Suorituskykyyn vaikuttavien aineiden väärinkäyttö. Käytännön Lääkäri 3: 129–135.

Taimela & Seppälä (1994): Voimaharjoittelussa käytettävien anabolisten aineiden haitat. Suomen Lääkärilehti 20–21: 2051–2061.

Karila, Hovatta, Seppälä (2004): Concomitant abuse of anabolic androgenic steroids and human chorion gonadotropin impairs spermatogenesis in power athletes. Int J Sports Med 25: 257–263.

Kanayama, Hudson & Pope (2008): Long-term psychiatric and medical consequences of anabolic–androgenic steroid abuse: A looming public health concern? Drug and Alcohol Dependence 98: 1–12.

Mäntysaari, Karila & Seppälä (2005): Cardiovascular findings in power athletes abusing anabolic androgenic steroids. International Review of the Armed Forces Medical Services 75: 12–15.

Thiblin, Mobini-Far & Frisk (2009): Sudden unexpected death in a female fitness athlete, with a possible connection to the use of anabolic androgenic steroids (AAS) and ephedrine. Forensic Science International 184: e7–e11.

Pärssinen & Seppälä (2002): Steroid use and long-term health risks in former athletes. Sports Medicine 32(2): 83–94.

Giammanco, Tabacchi, Giammanco, Di Majo & La Guardia (2005): Testosterone and aggressiveness. Medical Science Monitor 11(4): 136–145.

Pärssinen, Kujala, Vartiainen, Sarna & Seppälä (2000): Increased premature mortality of competitive powerlifters suspected to have used anabolic agents. International Journal of Sports Medicine 21: 225–227.

Side effects of testosterone preparations | UroWeb.ru – Urological information portal!

The FDA warns men who take testosterone-containing drugs previously approved by this organization about the possible risk of developing cardiovascular diseases: cerebral infarction and myocardial infarction, while not excluding a high probability of death.

Testosterone traditionally refers to male sex hormones. Testosterone-containing drugs, approved by the FDA, are intended for medical use only in men with testosterone deficiency. FDA-approved testosterone preparations include topical gel, transdermal patch, buccal system with fixation of the latter to the oral mucosa, and liquid dosage forms of the hormone for injection.

The decision to review the safety of these drugs was made in connection with the recent publication of two separate studies, on the basis of which there is evidence for an increased risk of cardiovascular events in men receiving testosterone therapy.

The first publication that prompted the FDA to reconsider cardiovascular safety in testosterone therapy was an analysis of a major study published in the Journal of the American Medical Association (JAMA) in November 2013. Older men included in this study had low testosterone levels in serum. Patients underwent coronary angiography to assess the presence of coronary artery pathology. On average, the men included in the study were in their 60s, and many were diagnosed with cardiovascular disease. In the group of patients who were prescribed testosterone therapy, the study identified a 30% increase in the risk of stroke, heart attack, and even death.

A second observational study suggests an increased risk of heart attack with testosterone supplementation in men with a history of heart disease. A two-fold increase in the risk of developing a heart attack in men over 65 years of age during the first 90 days after the first administration of testosterone has been reported.