Q: I was looking forward to getting the much-talked-about testosterone patch, so I’m disappointed it wasn’t approved. What are my alternatives?
A: The testosterone patch was a focus of many women’s dreams. Alas, the patch, which was designed to enhance a woman’s sexual desire, remains a dream, at least for now. Several weeks ago the FDA, concerned that trials had not gone on long enough, denied approval of the patch, requesting more data and follow-up.
But before you give up on either this drug or your sexual fantasies, let’s look at some sexual realities.
Women assume that testosterone, the male hormone, is produced only by the opposite sex. But we do make our own testosterone. Less does more — we have only about 1/20th the amount men do. We first produce this hormone during puberty. As a result, we start developing pubic hair, acne, malodorous perspiration … and an interest in sex.
Testosterone helps maintain bone and muscle mass, and is important to sexual functioning, including fantasy, desire, arousal and orgasmic response.
We need very little male hormone to do this (and most of what we do have is “bound up” in the body, leaving an even smaller amount — the so-called “free” testosterone — to influence sexuality). The issues with free testosterone usually begin as we go through our 30s and 40s, when we lose up to half of the male hormone made from our adrenal glands. There may also be an additional loss from our ovarian source.
But before bemoaning this loss as a cause of your diminished sexual response, you should understand that enjoyment of intimacy is far more complex than a simple hormonal equation.
Five years ago, when I wrote my book “I’m Not in the Mood: What Every Woman Should Know About Improving Her Libido,” my practice had an onslaught of desire-impaired patients demanding hormone tests and testosterone supplementation.
Many of these women did not have problems with lack of male hormones; rather, they had issues with their self-image. Some were taking medications — such as anti-depressants, anti-hypertensives, anti-cholesterol drugs — that affected their libido and sexual response. Others had relationship problems, and their fights in the living room accompanied them into the bedroom.
To establish whether you “need” testosterone, your doctor should check the level of free testosterone in your blood. This will be low if you have had your ovaries removed. It might also be low if you take medications that bind up testosterone, such as certain types of birth-control pills or oral estrogen.
If you are menopausal and have established that boosting your testosterone might be helpful, you can take an FDA-approved combination estrogen-testosterone pill, Estratest.
If you do not take estrogen, or take a non-oral form of estrogen, talk to your doctor about adding compounded testosterone, made by a compounding pharmacy. (This is a drug store that creates custom prescriptions, as opposed to a regular pharmacy, which distributes medications made elsewhere.) Testosterone can be formulated in the form of a cream, ointment, capsule, sublingual drops or lozenge placed under the tongue.
Dosages should be kept to an absolute minimum. Too much testosterone can cause oily skin, acne, growth of body hair and, in large doses, deepening of the voice or even enlargement of the clitoris.
There also is concern that testosterone can adversely affect cholesterol levels, which is one reason for further study of the patch. So your doctor should monitor testosterone supplementation by checking your cholesterol levels and liver function before you start therapy and six months later.
Dr. Reichman’s Bottom Line: Despite the non-approval of the testosterone patch, it is still possible to prescribe male hormone to testosterone-deficient women who are short on sexual desire.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of .
PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.