Testosterone “Replacement” in Post-Menopausal Women for Libido

Testosterone is linked with sexual desire in both men and women. Women normally produce testosterone throughout the life cycle. Although postmenopausal ovaries continue to produce testosterone, levels naturally decline with age. Testosterone blood levels decrease approximately 50 percent by age 50, which may play a role in the decline in libido (using masturbation frequency as a partner-independent proxy). A syndrome of “female androgen deficiency” symptoms has been popularized, but there is no evidence testosterone “replacement” helps with mood or well-being, hot flashes, or bone, cardiovascular, or metabolic health. The only evidence-based reason to try testosterone in postmenopausal women is for the treatment of low sexual desire that’s causing distress.

A systematic review and meta-analysis of three dozen randomized controlled trials involving more than 8,000 women found that testosterone treatment significantly increased postmenopausal sexual desire. The increase in frequency of “satisfactory sexual events” was statistically significant, but not clinically significant enough to warrant FDA approval, especially given the uncertainty about long-term side effects. The women on testosterone only logged a little under one additional satisfactory sexual event a month, compared to placebo.

Currently, there are more than thirty FDA-approved testosterone products for men, but none for women. Clinicians can trial a few months of a male transdermal testosterone preparation at one-tenth the dose or less, making sure to check levels to prevent overdosing, which can have virilizing side effects, such as clitoral enlargement and voice changes. Even at premenopausal physiological doses, testosterone can cause acne and excessive hair growth on the chin, cheeks, and upper lip. Unlike oral testosterone, formulations administered through the skin don’t appear to have the same negative effects on cholesterol levels, but long-term safety data for women regarding cardiovascular, cancer, and cognitive outcomes are lacking.

It has been estimated that more than a fifth of prescriptions for male testosterone products are actually written for women, and this is not including custom-compounded testosterone. A consensus position statement of international medical societies specializing in hormone issues recommends against compounded “bioidentical” testosterone due to the lack of evidence for efficacy and safety. Similarly, the dietary supplement DHEA, which can convert into testosterone within the body, cannot be recommended for low libido in women, since a meta-analysis of more than 20 randomized controlled trials found no significant effect on improving desire and sexual function.

Are there any natural ways for women to raise their testosterone levels? Listening to music for just 30 minutes can increase testosterone levels in young women by about 20 percent. Interestingly, the opposite effect is found in men. For more on the effects of music, check out my video Music as Medicine.

Heavy mint consumption may lower testosterone levels in both men and women. There are case reports of men drinking four cups of day of spearmint or peppermint tea losing their sex drive. Given the apparent anti-androgenic effects, researchers decided to try it out on women concerned about excessive hairiness, and in a matter of just five days, were able to drop their free testosterone levels by about 30 percent with two cups of mint tea a day. There’s a syndrome called PCOS, or polycystic ovarian syndrome, which can result in abnormally high testosterone levels in women, which can be successfully brought down with mint tea, but for women struggling with low libido, it might not be a good choice.