Testosterone for libido? I don’t think so…
Written by Dr Karen Morton, Consultant Gynaecologist and Obstetrician and Founder of Dr Morton’s – the medical helpline©
I have always seen lots of women seeking advice about their dwindled sex-drive or ‘libido’. The commonest age group is 40 to 60 year olds. They all hope there is a simple remediable cause such as ‘the change’. If they are still having regular periods then it is impossible to attribute their problem to any malfunction of the ovaries. It is egg production that tells the uterus what to do. There is no point in measuring any hormone levels. Regular periods = normal ovarian function.
After the menopause, when ovaries have stopped making oestrogen, the vulval and vaginal tissues become undernourished, and dryness and soreness can become a problem. If this is the case, sex will be painful and as I say to these lovely women “If it hurts, why would you want to do it?” This problem can usually be easily remedied immediately by using a really good lubricant like YES, and then by giving the vagina some nourishment with oestrogen, either with a cream or a pessary (a tablet placed in the vagina). The full benefit will not be noticed until three months by which time the vaginal lining will have grown from its deepest layer to the top layer in a plump, pink and juicy condition. That is how long it takes for skin turnover; we lose a suntan in three months. Sometimes the oestrogen nutrition and the lubricant are needed together and sometimes lubricant on its own will be sufficient and it can be bought over the counter.
Other women chose to take hormone replacement therapy through the blood stream, either by taking a tablet or applying a skin patch, and this nourishes the vagina as well as doing all the other things that HRT is intended to do, such as treat hot flushes and prevent bone thinning. If sex isn’t hurting, then I usually go on to say that sex drive is a very multi-factorial thing; something intangible, magical. The George Clooney test “I used to apply what I called ‘the Piers Brosnan test’ but I am afraid his performance in Mamma Mia with his attempts at singing forced me to re-evaluate, and now I call it ‘the George Clooney test’. The George Clooney test is that if George Clooney was to come in here right now, preferably wearing a dinner jacket, carrying a bunch of red roses, and he takes you out to a lovely restaurant, wines and dines you, and then takes you to the dance floor, would that get your drives and juices going? If it would then there is nothing the matter 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. I had an influx of women following an article in the Daily Mail last December in which a woman claimed that taking testosterone had transformed her sex drive. It seemed to me to miss the truth of the matter. It was the opening line of the article which said it all. ‘But Kim is 57 and her husband of 3 years is a 64-year-old retired scientist.’ This was not a relationship which had had to survive the child-rearing years and other stresses and strains of being together through thick and thin. This couple had chosen to be together recently and were so fortunate to have found each other. Each thought that the other was just delicious. Some couples are blessed to have sustained those same feelings throughout decades together, and how wonderful is that! But many couples have endured, and fallen apart; both parties feeling unloved and unappreciated, and certainly not the least bit sexy.
What of testosterone? I am not saying it is irrelevant but it is definitely of minor importance by comparison with the newness or enduring vitality of the relationship, together with the health of the vaginal tissues. Testosterone is unlicensed for this use, and the majority of women over 50 will be familiar with the need to own an expensive reliable pair of tweezers and the horror that having no access to a good mirror brings. Most women pray that their best friend will ensure, if they themselves lose the plot, to scrutinize the chin and deal with any offenders immediately! I don’t need to be more explicit. Would I risk testosterone making this worse for very modest if any benefits? I would not.
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