Women taking testosterone advised not to tell partners

Women who are taking testosterone should not tell their partners because it could create “false expectations” in the bedroom, according to a new review that could find no direct link between the hormone and sexual desire in women.

Growing numbers of women are being prescribed testosterone for low libido, despite unknown long- term risks, “totally meaningless” tests used to measure the hormone in women and studies suggesting testosterone produces, at best, one to two more “sexually satisfying events” per month over a placebo, doctors say.

Despite these limits, “select cases” may benefit from testosterone therapy, conclude the authors of a paper appearing in the Journal of Obstetrics and Gynaecology Canada.

However, they caution it may be prudent for women to delay telling their partners, “otherwise false expectations on the partner’s behalf may alter normal sexual activities and distort the perception of efficacy.”

In an interview, co-author Dr. Robert Reid said that, in his experience, if a woman immediately confides in her partner, “what happens is, the husband says, ‘ oh great, she’s on a hormone to make her sexually crazy’ and they have sex every night.

“She comes back and says, ‘ we had sex every night.’ To the doctor, it sounds like, problem solved. But really, it was the partner’s expectation that led to the demand for sexual intercourse,” said Reid, chair of the division of reproductive endocrinology and infertility at Queen’s University in Kingston.

There are no testosterone gels, creams or patches approved for use in women in Canada. However, gels approved for men are being widely prescribed “off label” to women in doses anywhere from one- third to one- tenth the daily dose prescribed for men.

Women rub the gels into their armpits or calves. “You put it some place you don’t mind seeing hair growth,” Reid said. Risks can include acne, androgenic alopecia ( male pattern balding), a lowered voice or change in aggression in too-high doses, worsening blood fats, and “as yet undetermined” longterm effects on heart disease and breast cancer, Reid and his co-author write.

“Sexual response is a complicated affair,” leading Canadian sex researcher Rosemary Basson has argued, and exactly what role testosterone plays in women’s sexual dysfunction is controversial.

After menopause, a woman’s testosterone production drops by about 25 per cent.

For women who have had their ovaries removed, circulating testosterone falls 40 to 50 per cent.

Pooled estimates from 35 studies involving nearly 4,800 menopausal women found those who received testosterone had “improved sexual function scores” and a slight increase ( one per month) in the number of “satisfying sexual episodes,” Reid and his co- author, Dr. Ann Kathryn Korkidakis, report.

Reid stressed that other f actors — i ncluding f atigue, stress, relationship problems and such libidosuppressing drugs as antidepressants — should be ruled out before a woman is given a trial.

About a third of women benefit, he said. “The other two- thirds come back and say it didn’t make any difference. So I say, well, stop it.”

Testosterone is thought to prime the brain to make it more vigilant to sexual cues. Still, it’s not clear at what level a woman can be said to be “deficient.” What’s more, most commercially available tests used to measure testosterone in women were originally developed for and validated on blood levels in men, “which are 10 times higher than they are in women,” says Dr. Lori Brotto, of the University of British Columbia’s sexual health lab.

Brotto worries the new paper will lead to wider offlabel prescribing of testosterone to women.

In 2004, a U. S. Food and Drug Administration advisory panel rejected approving a testosterone patch developed by Procter & Gamble for women, saying there wasn’t sufficient safety data. Two years ago, Canadian and American regulators issued new warnings linking testosterone replacement products with an increased risk of heart attack and stroke.

Ottawa obstetrician/gynecologist Dr. Jonathan Huber said studies showing a modest benefit of testosterone supplementation for women are flawed and don’t make logical sense. “The largest drop in testosterone occurs in women in their 30s, at a time that we normally associate with a woman’s sexual peak,” Huber said.

In addition, he says a spontaneous, innate sex drive, like a hunger for food, doesn’t exist “and isn’t important to drive (a woman’s) sexual interest or behaviour.

“When women talk about sexual interest, what they’re really talking about is a response to the context around them, and it’s this context that isn’t examined properly,” Huber said.

But other doctors say, with no approved sex drugs for women, there are no other options.

Quebec drug giant Valeant Pharmaceutical’s pill for low libido in women, marketed as Addyi in the U. S., has been under review by Health Canada for more than a year.

Sales in the U. S. have been lacklustre. In addition to its cost ( as much as US$ 800 per month), Addyi carries a black box warning that it cannot be taken with alcohol.

Testosterone doesn’t carry a prohibition against alcohol, Reid said.

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