Testosterone Replacement For Low Libido In Perimenopause

A consensus statement from an international panel of experts has finally weighed in on the topic of testosterone therapy for sexual function in perimenopausal women. There are many contributing factors to sexual function at any age and a careful history and physical should be conducted to rule out any other causes of hypoactive sexual desire. However, this paper acknowledges the role of decreasing testosterone levels in women as a moderate contributing factor worthy of evaluating and addressing. This is something that many clinicians have known for a long time and have treated patients accordingly, but it is nice to have the support and acknowledgement of the major endocrine societies that have contributed to the statement.

Though a specific FDA-approved testosterone replacement for women does not exist, the recommendations support the use of an FDA-approved product for males at decreased doses or an equivalent compounded product via a reputable pharmacy. The statement does not support the use of pellets or injections as these delivery methods often cause supraphysiological testosterone levels which may be dangerous or cause side effects over time. The paper states that testosterone replacement may be a safe and effective treatment for women who demonstrate low levels of total testosterone on blood tests as long as replacement doses do not produce supraphysiological levels. Testosterone can be administered for this purpose via a gel, cream, troche, or lozenge. The panel also calls for more research to be done in this understudied, undertreated area of women’s health.

Testosterone isn’t the only therapy for the treatment of hypoactive sexual function in women. Over-the-counter topicals like Replens or RepHresh can help moisturize dry vaginal tissue. Maca has been found in several studies to improve libido. Acupuncture has been shown to decrease the low libido common in anti-depressant therapy and to reduce the discomfort and improve satisfaction in women with vulvar pain. Estrogen therapy, both vaginal and systemic, can be useful in both issues of low libido and vaginal pain with intercourse. DHEA has been approved by the FDA and shown in several studies to improve the health of vaginal tissue. There are some medications that can interfere with sexual function and, of course, these should be identified and alternatives discussed if possible. Therapy, either individual or couples, may be appropriate for some. If pain is a contributing factor, a pelvic physical therapist should be consulted. Flibanserin (Addyi) is an FDA-approved medication, but needs to be taken daily and can cause side effects like dizziness, low blood pressure, and fainting. Bremelanotide (Vyleesi) is an FDA-approved injection to be used prior to sexual activity, but it too can cause cardiac side effects. Both of these medications are very expensive and often not covered by insurance.

The position statement not only paves the way for more women to access effective therapy for their low sexual function, but my hope is that it will also open the lines of communication between women and their providers on this often sensitive and largely ignored issue.