Hormones Can Help Some Love Lives But Can They Hurt Too? Experts Urge Caution to Women Considering Hormone Therapy

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By Jane Schwanke
WebMD Medical News

Reviewed by Dr. Pamela R. Yoder

If your love life lacks luster, this news from the American College of Obstetricians and Gynecologists (ACOG) isn't going to help much. Millions of women suffer from loss of sexual drive or libido, and many of them are using androgen treatment or testosterone therapy to help boost their sex drive.

Now in a statement recently released by ACOG, a committee of experts recommends that physicians "be cautious when considering androgen therapy to treat low sex drive in women." If androgen is used, the committee recommends low-dose pills, rather than injections or products applied to the skin like gels, which are harder to monitor, and that all side effects are watched carefully. Steven J. Ory, MD, an author of the statement, says, "This is an issue that now has a great deal of public interest. This report was an analysis of literature that has been, for the most part, available for several years." Ory is chairman of the American Society for Reproductive Medicine Practice Committee and is in private practice in Margate, Fla.

According to ACOG's position, "Patients most likely to benefit from androgen therapy are young women who have undergone [removal of the ovaries]. Although it is possible that other women experiencing decreased libido may benefit from a trial of androgen therapy, the lack of definitive data should lead to a cautious approach."

Experts are learning more and more about how these hormones work in the body and along with that comes more knowledge about safety and effectiveness.
And although androgen therapy has been prescribed for sexual dysfunction in women for many years, information is still incomplete, and androgen therapies
have not been shown to consistently improve sex drive. Marvin A. Heuer, MD, vice president of research at Florida Medical &Research Institute in Gainesville, is a bit surprised about the latest waving of the caution flag. "We've been using testosterone for years," he tells WebMD. The statement may be designed to minimize overuse, he says. Still, Heuer admits, "Part of the problem with supplementing testosterone is that women have a normal level when their ovaries are functioning. When we start supplementing, we always go fairly high and tend to over-shoot that normal level. Then you start to get the side effects ... but some side
effects, like a change in voice, are irreversible." And although the news may come as a surprise to many women, too, many others already have found that androgen therapy has not proven to be the saving grace they had hoped. In addition, the negative side effects such as acne, facial hair, hair loss, liver damage, and increased cholesterol levels already have become apparent.

A lot has to do with the psychological changes that fluctuating hormones can create, according to Heuer. "But several other things are being looked at
that affect a woman's sense of well-being and libido it's not always the hormones." Sharon A. Winer, MD, MPH, agrees. "For both men and women, there's a huge psychological or psychosocial component that goes into it," she tells WebMD. "It's much more multifocal than whether the hormones are there or not."
Winer is an attending physician in Obstetrics and Gynecology at Cedars Sinai Medical Center in Los Angeles and professor of Ob/Gyn at the University of
Southern California.

The issue of women's libido has grabbed the attention of researchers, too. From California to Pennsylvania, at least 20 separate research projects are under way to study female sexual function. "In the next two to three years," Heuer says, "we're going to see a big upsurge in doctors that are willing to talk to women about these concerns and help them solve their [sexual] problems. "The good news is that doctors are more aware of [female sexual dysfunction]," Heuer says. "In the past, if a woman had a problem with her libido or hot flashes, they just had to tough it out. These days, that's not the case. There's a lot that can be done and we're learning more about that every day."

In the meantime, Winer says she will still prescribe androgen therapy for the patients who really want it. "I'm not going to offer it to my patients across the board, at this point not because I don't believe in it," she says, "but because in terms of doses and side effects, I can't give women the reassurance that most of them want."