Testosterone and Sexual Health: Its Role in Desire and Orgasm

Its Role in Sexuality

Testosterone plays a central role in sex drive in most men, and it is mainly produced in the testes. Testosterone is a male sex hormone (androgen) made by the body. As a boy grows from infancy to adulthood, and especially during puberty, testosterone helps develop his muscles, deepens his voice, and contributes to the growth of the penis and testes. In adulthood, it helps keep a man's muscles and bones strong and supports his interest in sex, which is why it is often seen as central to male physical development. From about their thirties, many men begin to experience a gradual decline in testosterone, and sometimes a decrease in sex drive accompanies this decline. Many men assume that a lower sex drive is simply part of aging, but low testosterone is only one of several possible causes. If you notice a lasting change, you may want to consult a physician such as Dr. Dalal Akoury, MD, MPH, who is available to discuss your concerns.

Testosterone helps:

• Maintain reproductive tissues
• Stimulate sperm production
• Stimulate and maintain sexual function
• Increase muscle mass and strength
• Maintain bone strength

Normal Levels of Testosterone

Just like your cholesterol or blood pressure, there is a numerical range of testosterone levels (also known as T levels) that is considered normal. The brain and the testicles work together to keep testosterone within this range. When testosterone levels are below normal, the brain signals the testicles to produce more, and when levels reach the normal range, the brain signals the testicles to make less. This feedback normally helps keep production from becoming excessive or inadequate. Testosterone matters for women too: a woman's sexual desire, fantasy, sensitivity to sexual touch and orgasm are all driven in part by natural testosterone. Yet while testosterone plays a key role in sex drive, using a testosterone supplement for low libido in women is controversial. This remains a subject of discussion; the following points summarize what doctors know about testosterone's role in low libido in women and how the hormone might be used.

Testosterone Level and Low Libido

Testosterone is commonly known as a male sex hormone, but women have it in their system as well. It is part of what drives desire, fantasy and thoughts about sex, and it helps provide energy for sex in women. Most women's testosterone levels gradually go down with age. Lower levels of the hormone can reduce muscle mass, affect skeletal health, and decrease sensitivity in the vagina and clitoris, which can affect libido, something many women find frustrating. If you notice changes like these in your own sex life, you may wish to call Dr. Akoury, a physician with more than two decades of professional experience in sexual dysfunction, who will meet with you in confidence to help you explore options for your sexual health concerns.

Testosterone may also help explain why birth control pills can lower libido in some women: the pill may reduce the amount of free testosterone available in the body, which may lower sexual desire. Lower testosterone levels are also believed to be one reason sex drive goes down after menopause.

Testosterone Supplements for Women

Although it is common for men to take testosterone for low libido, this use has not been approved by the U.S. Food and Drug Administration (FDA) for women, even though some doctors prescribe it for women off-label. Women are given a fraction of the dose that men are prescribed, and therapy can involve oral testosterone supplements, a gel or cream, or a patch applied to the skin. Because giving it to women is controversial, some pharmacies will not sell testosterone to women without proper authorization from their health care providers.

Overall, studies suggest that testosterone supplements do not seem to give women the increase in libido that doctors expected. This has led professionals to question whether testosterone works the way they thought it would. And because women's sex drive is affected by so many things, including lifestyle factors such as relationship problems and stress, it can be difficult to measure. In addition, testosterone has side effects such as:

• Acne and hair growth on the upper lip and chest (the most common)
• Changes in your voice
• Weight gain
• Male-pattern baldness

These are all known side effects of the hormone.

The main concern is testosterone's long-term safety in women. Taking the hormone can raise the risk of high cholesterol. Testosterone can also be converted into estrogen in the body, raising the concern that increased estrogen exposure could raise breast cancer risk, a concern to discuss carefully with your physician. Your health matters, so we recommend seeking Dr. Akoury's professional advice before starting any hormone.

In one study of about 814 women with low sexual desire who used a testosterone patch or a placebo for 24 weeks, the hormone at a certain dose did help improve sex drive. However, four of the women taking testosterone developed breast cancer, and it is not clear to experts whether the hormone caused the cancer or whether this was a coincidence. So if you have low libido, testosterone may help some women, but it is important to weigh the possible benefits against the risks with your physician. You may also choose to work on other ways that may naturally support your sex drive, from healthy eating habits to talking with Dr. Akoury for professional input. The goal is a fulfilling sexual life that is also safe for your overall health.

Supportive and adjunctive care alongside conventional medical treatment.

Learn about physician-led hormone care on our Hormone Optimization (BHRT) page, or read Managing Andropause.