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Use of Testosterone in Woman to Enhance Sex Drive Is Questioned in JAMA Article

Posted Sep 13 2008 3:59am
A medical report published recently in the Journal of the American Medical Association* states �tests of male hormone levels in women�s blood cannot predict diminished sexual function and should not be used in deciding on a course of treatment.� I disagree.

The findings are the product of a new Australian study in which more than 1,000 women participated. The results seem to indicate that the widely assumed belief among sex researchers that low sexual desire in women is based on low testosterone levels is not correct. The study found that an overriding number of women with low hormone levels did not have low levels of sexual function.

�If a woman with low libido asks her doctor for testosterone medication, there is no basis for that,� says Dr. Susan Davis of Monash Medical School in Victoria, Australia, the lead author of the study.

Despite these findings -- based on my clinical practice, experience, research, and research of others -- I still firmly believe that testosterone does play a crucial role in women. When testosterone levels are low, and women are experiencing symptoms of low libido, low energy, moodiness and irritability, and loss of muscle mass, testosterone replacement is beneficial.

A recent evidence-based Position Statement from The North American Menopause Society (NAMS), titled �The role of testosterone in postmenopausal women,� concurs. �Testosterone therapy has been shown to improve sexual function in many postmenopausal women, primarily the symptoms of sexual desire, arousal, and orgasmic response.�

Based on clinical trial evidence, postmenopausal women who report decreased sexual desire may be candidates for testosterone therapy, but they should first be evaluated for other causes of their sexual concerns, more appropriately treated with alternative approaches. Conditions that can decrease sexual desire include psychosocial issues (such as stress, fatigue, or relationship conflict), psychological disorders (including depression or anxiety), medical conditions (such as vaginal atrophy or hypothyroidism), and drug use (including antidepressants and alcohol).

The important issue here is that there is not going to be a magic remedy for all women and treatment, including hormonal therapy, needs to be individually tailored to meet each woman�s needs. If a woman has a low testosterone levels, and is not symptomatic, I agree with Dr. Davis, testosterone replacement is not indicated.

The only things doctors and researchers agree upon is the fact that women�s drive is so complex that a woman�s physiological condition is just one participatory factor in the mix. Age, partner specific issues, the quality of the relationship and lovemaking, attitudes based on upbringing and religious background and other psychological factors have much to do with a woman�s sexual beliefs and behavior. Obviously, as we age, sexual drive seems to diminish.

�The only current indication for testosterone therapy in postmenopausal women is to treat sexual concerns, primarily decreased sexual desire,� said Jan L. Shifren, MD, Chair of the Editorial Board for the NAMS Position Statement. �No other use is supported by the scientific literature, including increasing lean body mass, reducing hot flashes, or improving bone density.� Dr. Shifren is Assistant Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, and Director, Menopause Program, Vincent Obstetrics and Gynecology Service, Massachusetts General Hospital, Boston.

Menopause or surgical procedures such as removal of the ovaries definitely cause decreased sexual desire. Most women with sexual dysfunction can be helped but the right treatment must be based on an individual diagnosis.

*Circulating Androgen Levels and Self-reported Sexual Function in Women Susan R. Davis, MD, PhD; Sonia L. Davison, MD; Susan Donath, MA; Robin J. Bell, MD, PhD JAMA. 2005;294:91-96).

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