There have been recent attempts to address the problem of female sexual dysfunction with FDA attempted approval of a testosterone patch. It is recognized that a decrease in sexual function and desire occurs with the progression of menopause, which is a time of falling hormone levels and that testosterone is the primary hormone linked to libido. Is it really that cut and dry?
Female sexual dysfunction is a common problem for woman of all ages. It is classified into four categories: sexual desire disorder, sexual arousal disorder, orgasmic disorder and sexual pain disorder. As one may imagine, evaluation and treatment of the problem is much more complex than the supplementation of a single hormone.
Sexual desire disorder is an absent or decreasing interest in sexual relations. This may occur primarily or secondarily. In other words, a woman may state she has never had any sexual desire or that she used to desire sex but that desire has diminished considerably or is now absent. These women generally never initiate sexual encounters.
The second category, sexual arousal disorder, is the inability to become sexually aroused even with physical, mental or emotional stimulation. The woman may desire and even initiate the encounter but is unable respond with typical arousal reactions like vaginal lubrication.
Orgasmic disorder is the inability to climax with what would be considered adequate sexual stimulation. Again, a woman may report that she has never been orgasmic or that she was at one time orgasmic but is no longer able achieve orgasm with sexual stimulation.
Finally, sexual pain disorder is the perception of pain during a sexual encounter making that encounter difficult and unpleasant. The pain may occur in a number of locations.
As you can imagine, a woman may fall into any of these categories for a variety of reasons. Depression is a very common cause of Female Sexual Disorder (FSD). The depression may not be related to the sexual partner or relationship but may very easily affect sexual functioning. Chronic illness may also affect sexual functioning as may a history of sexual abuse, domestic violence, gynecologic disorders and medications. Because of the varied reasons, it is a problem that affects all ages.
Why then do we tend to focus on the menopause as a time for the diagnosis and treatment of FSD? Let’s look at the physiology to find out.
Women normally produce 0.2 to 0.3mg of testosterone daily. 50% of this occurs in fat stores while the ovaries and adrenal gland contribute the other 25% each. This changes slightly mid-cycle when the ovary increases its production 10-15%. At the time of menopause, levels drop to one-half of the previous levels and even lower in women who have had their ovaries surgically removed. Testosterone is associated with sexual desire and significant decreases of this hormone are associated with a decline in desire and consequently activity. What is important for us to remember, however is that if we are going to supplement testosterone, we should do so at physiologic levels to, as close as possible, mimic the levels we produce.
How do we do this? First, by checking our levels to determine where we’re starting. There may not be a problem with a low level but one of the previously named causes and giving more testosterone to someone who not deficient will cause or contribute to a hormone imbalance. My understanding is that the patch that is under investigation is a 8.4mg patch. It is not clear whether this patch is to be changed weekly or bi-weekly but in any case it’s more testosterone that we normally produce. I am not opposed to supplementing testosterone, mind you, I prescribe for my patients all the time. But prior to starting I check their levels and then, if necessary, supplement with the smallest amount of cream possible daily. Often, there is another deficiency, such as estrogen and testosterone does not have to be supplemented at all.
We cannot forget the delicate balance that exists between the ovaries, adrenal glands and thyroid gland. If one is not functioning properly, it can affect the way the body responds to otherwise normal levels of hormones. For example, progesterone competes with testosterone for an enzyme that converts testosterone to the more active dihydrotestosterone. Elevated levels of progesterone may produce symptoms seen in testosterone deficiency though no deficiency exists. Similarly, the hormone estradiol competes with testosterone at the receptor level. Elevated estradiol will mimic testosterone deficiency.
This is also true on a nutritional level where decreased zinc levels will result in decreased testosterone and increased estradiol levels because zinc is necessary for certain enzymatic conversions. Boron increases both testosterone and estrogen levels and inadequate boron intake may result in a deficiency of both.
What is the bottom line? Be informed about hormone delivery systems and the possible consequences of hormone excess and deficiencies. FSD may be the result of hormone imbalance and deficiency but has many other causes. Be honest about other possible reasons sexual desire and functioning may be on the decline. Your physician cannot assist you without all the necessary information. And be certain that your diet is balanced and that you are taking adequate vitamins and supplements. They are essential in our daily biochemical processes.