Unravelling the Complexities of Libido Loss and Menopause: Testosterone Isn’t Always the Answer
As women navigate through menopause, many may experience a decline in their libido, leading to concerns about their sexual well-being and overall quality of life. While it is tempting to assume that testosterone is the missing ingredient in addressing this issue, it is crucial to understand the intricate relationship between hormones, particularly testosterone and oestrogen, and why testosterone isn’t always the first solution.
This blog aims to shed light on the importance of maximizing oestrogen levels, the non-linear relationship between libido and testosterone, psychosexual aspects of low libido, and the potential benefits and risks associated with testosterone supplementation in women during menopause.
Maximizing Oestrogen Levels: The Priority
Contrary to popular belief, it is important to focus on maximizing oestrogen levels before considering testosterone as a solution for low libido during menopause. Testosterone, when administered to women, is often converted to oestrogen by the aromatase enzyme. Therefore, ensuring optimal oestrogen levels is essential for the proper functioning of the female reproductive system. Insufficient oestrogen can lead to a condition called vaginal atrophy, which may not always exhibit noticeable symptoms but can still impact libido. The brain responds to this oestrogen deficiency by downregulating testosterone production, further reducing libido. Vaginal oestrogen pessaries can help alleviate the symptoms of vaginal atrophy and contribute to an improvement in libido.
Understanding Testosterone in Women:
Testosterone plays a complex role in female sexual function, testosterone is produced not only in the ovaries but also in the adrenal glands. While it is commonly associated with libido, the relationship between testosterone levels and sexual desire is non-linear. Women can experience high levels of testosterone and still have a low libido, just as they can have low testosterone levels and a high libido. This indicates that other factors, such as psychological and emotional aspects, contribute significantly to sexual desire. Testosterone alone cannot be considered the missing ingredient in HRT prescribing for menopausal women.
Psychosexual Aspects and Counselling:
Low libido during menopause is not solely a hormonal issue. Psychosexual factors, including stress, anxiety, and relationship dynamics, can profoundly impact sexual desire. Addressing these aspects is crucial in resolving libido-related concerns. Counselling and therapy can provide women with the tools to explore their emotions, enhance communication within their relationships, and regain sexual satisfaction. Combining psychological support with hormone optimization can yield more comprehensive results in addressing loss of libido.
Debunking the Myth of Three Hormones:
It is a common misconception that menopausal women lose three hormones—oestrogen, progesterone, and testosterone—and that HRT only focuses on replacing the first two. In reality, women experience a more intricate hormonal transition. Hormone replacement therapy aims to restore the overall hormonal balance disrupted during menopause, considering multiple hormones and their interplay.
Risks of Excessive Testosterone Levels:
While testosterone supplementation can have benefits, it must be carefully monitored. Elevated testosterone levels in women can lead to adverse effects such as acne, hirsutism (excessive hair growth), voice changes, and even cardiovascular risks. Blood tests should be conducted before starting any treatment involving testosterone, and ongoing monitoring is essential to avoid potential complications.
Research and New Findings:
Recent studies have shed some light that their maybe potential benefits of testosterone supplementation beyond libido improvement, However, more research is needed to fully understand the effects of testosterone about joint aches and pains, brain fog, and low mood levels experienced during menopause.
Conclusion: Prescribing Testosterone Following Guidelines
When addressing loss of libido during menopause, it is essential to follow prescribing guidelines outlined by organizations like the National Institute for Health and Care Excellence (NICE). These guidelines emphasize the importance of maximizing oestrogen levels before considering testosterone supplementation. Psychological support, such as counselling, should be integrated into treatment plans to address the psychosexual aspects of low libido. Regular monitoring of hormone levels, particularly testosterone, is crucial to ensure optimal results while minimizing risks. By following these guidelines, healthcare professionals can provide a comprehensive approach to addressing loss of libido in menopausal women, considering individual needs and optimizing overall well-being.
The Menopause Consortium, as a registered stakeholder in NICE, remains vigilant in monitoring research and findings to consistently offer up-to-date, evidence-based information to support women during menopause.
Sources:
https://www.nice.org.uk/guidance/ng23
https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf
https://pharmaceutical-journal.com/article/feature/testosterone-for-menopause-why-women-face-difficulties-accessing-treatment
The British Journal of General Practice published this article in April 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098532/
Testosterone and Depressive Symptoms during the late menopause published July 2021 https://rdcu.be/dcMHq
https://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/testosterone-therapy/faq-20057935
