Menopause And Low Libido

By: Rallie McAllister, MD

For most women, menopause brings a bewildering constellation of emotional and physical changes. In addition to the hot flashes, night sweats, and mood swings that accompany the change of life, many women experience a depressing drop in sexual desire. Some of this drop is undoubtedly due to physical factors, but hormonal changes play an important role.

As with estrogen, the production of testosterone in women falls off sharply after menopause. Although the adrenal glands normally continue to manufacture small amounts of both hormones, the ovaries stop making them altogether. Most women will experience an 80 percent decline in estrogen levels, and a 50 percent reduction in testosterone levels.

Women who take estrogen replacement therapy during menopause usually experience a welcome relief of many of their menopausal symptoms, but the regimen may actually suppress libido even further. Taking supplemental estrogen tends to drive up levels of Sex Hormone Binding Globulin, which in turn binds to free testosterone in the body, making it less biologically available to fuel sexual desire.

While the effects of the estrogen deficiency that occurs with menopause are well understood, far less is known about the full impact of declining testosterone in the female body. Low testosterone levels are, however, consistently associated with lackluster libido in women. A recent study published in the Journal of the American Medical Association found that women with low testosterone levels are significantly more likely to suffer from fatigue, depression, and loss of libido than women with higher levels.

Although doctors have been prescribing testosterone replacement therapy for men since the 1930s, it wasn't until recently that the treatment was considered acceptable for women. In spite of its proven benefits, the treatment is still rather controversial. The potential for unwelcome side effects keeps many women from trying it, and likewise prevents many physicians from recommending it.

In a very small percentage of women, the use of supplemental testosterone may lead to a masculine deepening of the voice, the development of facial hair and male-pattern baldness, and the onset of acne. In some women, the hormone may drive up cholesterol levels. These side effects seldom occur at the low doses prescribed by doctors today, especially when administered simultaneously with the female hormone estrogen. When they do appear, the changes are usually quickly reversed with a reduction in dosage.

On the plus side, supplemental testosterone has been shown to improve energy levels, enhance feelings of well being, and dramatically bolster libido in menopausal women. For menopausal women who continue to experience hot flashes and night sweats even after taking estrogen, supplemental testosterone often provides relief. It also helps boost lean muscle mass, enhance short-term memory, and increase the elasticity of the skin, resulting in a younger-looking complexion.

Another benefit of testosterone replacement therapy in women is it ability to increase bone mass. While traditional estrogen replacement therapy is known to prevent the additional loss of bone, treatment with a combination of estrogen and testosterone goes one step further, stimulating the formation of new bone.

When it comes to taking supplemental testosterone, women's choices are limited by the availability of approved medications. Hormone replacement therapy consisting of estrogen and small amounts of testosterone is available in the form of a pill. Currently, the only estrogen-testosterone combination pill approved by the U.S. Food and Drug Administration is Estratest. This drug contains what most experts believe to be a balanced combination of the two hormones.

For women who can't or don't want to take combination estrogen-testosterone therapies, testosterone injections are available. Injections are typically given every two to four weeks, and most women tolerate them well and find them very effective in enhancing sexual desire.

Many pharmacists are now formulating low-dose testosterone creams, gels, and lozenges for their patrons. The testosterone contained in these products is typically derived from plant sources, which are "micronized" into tiny particles to allow for easy absorption. The creams and gels can be applied several times a week to an area of the body where the skin is thin. Testosterone-containing lozenges may be taken regularly, or they may be used on an "as needed" basis. Most women find these natural products to be very effective, and experience few unwelcome side effects with their use. Testosterone-containing creams, gels, and lozenges require a doctor's prescription, as well as the services of a pharmacist who is skilled in compounding the products. For menopausal women, testosterone replacement therapy can restore libido, and make the change of life a little easier to live with.

Rallie McAllister, MD, the author of The Busy Couples Guide to Great Sex: The Medically Proven Program to Boost Low Libido (LifeLine Press, September 2003), and Healthy Lunchbox: The Working Mom's Guide to Keeping You and Your Kids Trim (LifeLine Press, September 2003), runs a family practice specializing in nutrition, wellness, and weight loss called Healthy Solutions, in Kingsport, Tennessee. Dr. McAllister is the creator and popular host of Rallie On Health, a health magazine TV show with over 1 million viewers in the five-state area of eastern Tennessee. Millions across the country also know her for her weekly nationally syndicated column called "Your Health by Dr. Rallie McAllister." Dr. McAllister lives with her husband and three children in Kingsport, Tennessee. Visit Rallie at

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