Articles

The Hormones of Desire

By Paul Hueseman, Pharm.D.

Have you ever asked yourself the question: Where has my sexual desire gone? If you have, then you are not alone. This question often plagues women during their perimenopausal and menopausal years. Decreasing levels of estrogen, progesterone, and the androgens, including testosterone and dehydroepiandrosterone (DHEA), are often the primary culprits leading to these changes. Androgens are major determinants in one's sex drive including interest, arousal, sexual response, lubrication, and orgasm. Because of this, they are sometimes referred to as the hormones of desire, but beyond this, they also play a role in overall well-being, mood stability, energy levels, bone and muscle health, memory, and cognition.

Female concentrations of testosterone are only about 10% of those in males. During menopause, testosterone levels drop by 1/3 or more; DHEA, which is a weak androgen and a precursor to testosterone, peaks in a woman's 20s and then gradually declines with age. Both of these should be assessed for replacement just like estrogen. Assessment needs to take place prior to therapy to exclude higher levels of testosterone. The morning hours are the best time for testing because levels may vary throughout the day. Testosterone levels are lowest during the menstrual phase, so testing 8 days after the start of menstruation is best. While most studies of androgen replacement relate specifically to testosterone, some data suggests the age-related decline in DHEA may also be linked to cognitive declines, reduced immune function, insulin resistance, and the incidence of neoplasia.

Symptoms generally respond to hormone replacement. The goal of therapy is to tailor the dose of testosterone and DHEA to the individual, returning hormone levels back to where they were prior to menopause thus, eliminating annoying symptoms while avoid negative effects of excess androgens. The potential negative effects of excess androgens include susceptibility to hair loss, facial hair, acne or deepening of the voice.

Currently, there are no testosterone preparations approved for use in women; however, women with low libidos have used testosterone as treatment for years. Testosterone and DHEA are available individually as sublingual tablets or topical gels and in combination with progesterone and estradiol. Administration via the sublingual and topical routes avoids first pass metabolism in the liver. In other words, your body is absorbing more of the medication than it would if swallowing the medication orally. Before starting testosterone therapy to improve libido, you need to consider other reasons for this lack of sexual desire including poor partner relationship, depression, and/or poor well-being due to other causes.