4 minute read
The anatomy of
We think of testosterone as representing everything male, but it plays a crucial role in our oestrogen production, fertility and sexual functioning. And when levels drop after menopause, there’s a patch that can help. Anatomy of desire
WORDS by BROOKE LE POER TRENCH
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Like anchovies and Spanx, testosterone is polarising. Australia is the first and only country to have a regulator-approved testosterone cream for post-menopausal women, and yet there’s still confusion. One reason for this, according to Professor Susan Davis, director of the Women’s Health Research Program in the School of Public Health and Preventive Medicine at Monash University, who has led groundbreaking studies on the subject as it relates to women, is that we see it as a male sex hormone. “It’s essential in women’s bodies too, playing a role in the development of eggs and production of oestrogen,” she says. Another issue is that menopausal women don’t talk to their GPs about desire, or the lack of it. And when they do, many GPs don’t know what to do.“Studies show they don’t have the training or the interest to discuss sexuality,” she says. “Many feel it’s a can of worms.” But our ability to feel desire and connect with our partners in the Biblical sense matters. We asked Professor Davis everything you need to know about how testosterone may help you.
“There is a lack of awareness with mid-life women’s health and a whole generation of doctors who have not been taught about menopause because HRT [hormome replacement therapy] went off the radar. They also put sexuality in the too-hard basket. Women are, to a degree, also their own worst enemy because there is a consistent belief that they only need to see a doctor if they can hardly function.”
Burt Lancaster and Deborah Kerr sizzle in From Here to Eternity.
Q:Thereisacertain amountof fearthat addingtestosterone willcausesideeffects,likebodyhairanda deepvoice.Whatdo thestudiestellus?
“If the dose is right, then there are no side effects. We did a systematic review of all the studies looking at the risks of women taking testosterone, published in The Lancet, and they are just not there. We also have an enormous amount of safety data, and there is no adverse effect on cholesterol, insulin, blood pressure, red cell count or glucose. In fact, in these studies we had great compliance with women taking testosterone because it was working so well for them; it was women on the placebo that dropped out.”
Q:Whendoour testosteronelevels starttodrop?
“Between the ages of 18 and 39, blood testosterone levels fall by about 25 per cent. This is due to the ovaries and adrenals slowing down and producing less and less over time. It continues to decline with age.”
Q:Howdoesthisshow upinourdailylives?
“Before menopause, sexual functioning is very much determined by our general health, relationships and environment. And that’s not just where you live, but how you live, whether you’re on medication, whether you’re depressed, and cultural beliefs. For instance, if you were always taught masturbation was bad, then your sexual functioning is not determined by hormone levels, but rather your guilt and shame. So while testosterone contributes to female sexual function before menopause, the overriding effect is what is going on with the rest of your life.”
Q:Andafter menopause?
“By the time women go through menopause, a large proportion have a reduction in testosterone that does impact their sexual functioning. And the evidence is irrefutable that testosterone replacement will improve low desire in the majority of women. Although, as I say to my patients, ‘I can increase your desire, but I can’t make you like your partner’. So if the primary problem is your relationship or depression or just not being happy at work, it won’t fix it. But all the studies have shown that there is clear benefit for post-menopausal women taking testosterone.”
“It is a cream that comes out in a metered dose, which can be varied. It is a much weaker preparation than you would use to treat a man, so the margin for error is very small. If you do mistakenly use too much and get a little acne or oily skin, we adjust the dose a little.”
Q:Howdoes testosteroneaffect womenwhenthey usethepatch?
“It has central and peripheral body effects. In one study, menopausal women were exposed to non-erotic videos, like someone vacuuming the carpet, and erotic ones, followed by brain imaging. It wasn’t until they were given testosterone that their brains looked like those of premenopausal women being shown erotic videos. Physically, testosterone also increases vaginal blood flow and so it increases the ability to become aroused and to have an orgasm.”
Q:Onceyoustart usingthetestosterone patch,howlongdoes ittaketokickin?
“About four weeks. Many postmenopausal women will describe the feeling of not wanting to be touched. They will say, ‘I want to go to bed and read a book and put a big line down the middle of the bed between myself and my partner’. I explain to patients their first response to treatment will be that when their partner initiates, they won’t even think about pushing them away. That ‘don’t touch me’ feeling goes and the receptiveness changes first and then it comes back strongly.” AWW To find a doctor well versed on women’s health issues, visit the Australasian Menopause Society site at menopause.org.au and search “Find an AMS doctor”.
