More On Myths, Misogyny, and Misconceptions

In a previous blog entry, I told you my view on the three Ms (Myths, Misogyny, and Misconceptions) of female sexual dysfunction and why FSD isn't being recognized as a legitimate class of disorders as is male sexual dysfunction. Now I'd like to focus specifically on how the three Ms affect the acceptance of treatment of female sexual desire disorders with testosterone.

Testosterone is one of five androgen hormones found in both men and women, although men possess 10 to 20 times more testosterone than women. As both men and women age, a proportion of their testosterone is lost every year. By the time a woman reaches the age of 50, she has lost about half the testosterone she started with. Additionally, when a woman stops ovulating in menopause, her estrogen production drops precipitously.

Not all women experience a decline in sexual desire at this time, but many do. This reduction of libido is intensified by age-related loss of the hormones DHEA and DHEA-S, two precursors of testosterone. Several years after menopause, a woman may have lost up to 75 percent of her testosterone, so it's no surprise that many women suffer from a serious loss of sexual desire during this period in their lives.

We have known for at least 40 years that treatment with testosterone can restore sexual desire in many women who have lost it. We also know that, at least for the short term, testosterone treatment is safe; in large studies, the only noticeable side effects were slight increases in facial hair and acne. Testosterone in topical cream or gel form has been prescribed off-label to women for at least 40 years and no pattern of serious side effects has been noted. Testosterone is a natural component of the human body, not a foreign drug molecule. Why, then, is there such opposition in some quarters to testosterone treatment of female sexual dysfunction? This is where the three Ms come into play.

Criticism that there is no long-term safety data is a straw man, since there's almost never any long-term safety data available at the time a drug is approved by the FDA. These data are typically provided through monitoring of effects after the drug has been marketed.

Other critics suggest vaguely that testosterone treatment may increase the risk for developing breast cancer. If anything, the data available from the Women's Health Initiative study suggest that testosterone may actually protect a woman from developing breast cancer.

People who complain that sexual health experts are "medicalizing" FSD should recognize that, in spite of their personal wishes to the contrary, many causes of FSD are medical-biological in nature. This is certainly true with male sexual disorders; why should women be an exception in this regard?

If the fundamental cause of a woman's low sexual desire is androgen (testosterone) insufficiency, which affects a large proportion of postmenopausal women, it will take an awful lot of talking to bring about a cure.