While researchers continue to maintain that frequency of sexual activity is often a predictor of general well-being, one U.S. study found that nearly one-third of women of reproductive age, and over half of postmenopausal women complained of low libido.^[6]

The Role of Testosterone and Libido in Women

Scientists know that a number of factors influence sexual activity and sexual desire in women, including mood and feeling. Female sexual response also varies by culture, partner, and stimuli, as well as the production of androgens and the brain’s sensitivity toward androgen receptors.^[1]

Testosterone, the strongest of the male sex hormones, in addition to estrogen and progesterone (the female hormones), is primarily produced in the ovaries during the reproductive years. Other androgens, as well as a small amount of testosterone, are produced by adrenal glands and fat tissue, along with small amounts of estrogen. Testosterone is particularly important because it activates the sexual circuits in the brain.

Besides libido, testosterone plays a dramatic role in many other aspects of a woman’s physiology and quality of life, including, sexual satisfaction, bone density, vasomotor symptoms, body composition, and an overall sense of well-being.

While many medical conditions can lead to androgen deficiency in females, physicians and researchers know that in physically healthy women, androgen levels naturally decrease by about 50%, beginning in the early 20’s, through the mid 40’s. Deficiencies may be found in post menopausal women as well.^[2]

How can low libido affect happiness and general wellness?

There is much scientific evidence that links sexual behavior, quality of sex, and sexual frequency with well-being and happiness. In one study of women, sex was rated the number one activity that generated the most happiness within relationships. Conversely, other research indicates that individuals who had not had a sexual partner within the previous 12 months reported the greatest degree of unhappiness.^[4]

What type of test should be taken for low testosterone/low libido in women?

Prior to menopause, women produce most of their testosterone in the ovaries. Once menopause occurs, ovarian production is reduced dramatically. As a result, there may be changes in mood, as well as a decrease in female libido. Generally, a blood test for total testosterone (that measures testosterone bound to proteins in the blood), as well as free circulating testosterone, is administered. Much of the time, low testosterone levels correlate with loss of energy, fatigue, and diminished sex drive in older females.^[3]

Types of Therapy for Low Testosterone/Low Libido in Women

While the U.S. Food and Drug Administration does not currently approve the use of testosterone therapy for women with low libido, “off-label” prescribing by physicians who treat postmenopausal women skyrocketed in the early 1990’s. At that time, some studies demonstrated an “increased frequency of satisfying sexual encounters and intensity of sexual desire” with transdermal testosterone therapy. Symptoms including depression, insomnia, moodiness, and memory loss also appeared to improve when testosterone was combined with other hormone replacement therapies, such as estrogen. Testosterone can be administered to women by means of injection, patch, topical gel, pill, or implant.^[1]

Why Follow-up Testing/Monitoring is Important

During and after female testosterone therapy for decreased libido, it is important to continue to monitor blood levels in individuals. Because there is some concern over safety of testosterone therapy for women, and possible side effects such as liver damage and virilization (the presentation of male sex characteristics), much controversy over its use for low libido remains.

As with all hormone therapy, there is no “one-size-fits-all” solution. Low-dose, individualized treatment is the key to effective androgen therapy. Baseline and follow-up testing of testosterone levels is critical for maintaining hormone levels in a therapeutic range and avoiding the side effects of under- or overdosing.^[5]