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If all goes well, and the FDA gives its approval, the
testosterone patch could be available in one to two years.
Some women use testosterone products designed for men, but
these products have not been tested in large studies in women, and could
have 10
times more hormones than women need, says Mary Lake Polan, MD, PhD, MPH,
professor and chair of ob-gyn at Stanford
University School of Medicine in
California.
Too much testosterone in women could have masculinizing
effects, such as hoarseness or deepening of the voice, unnatural hair growth
or
loss, acne or oily skin, decreased breast size, increase in the size of female
genitals, and irregular menstrual cycles.
Additionally, other forms of testosterone such as creams and
gels do not have conclusive evidence that they work to boost women's libido.
Estratest
There is one FDA-approved androgen (male hormone) on the
market for women. Estratest is a combination of oral estrogen and
testosterone.
Although the product is only approved to treat
estrogen-resistant hot flashes, it has been used "off-label" by doctors and patients. Off-label
use
means physicians prescribe drugs for a purpose other than what they are
approved for.
Estratest has not been approved to improve sexual desire in
menopausal women, but double-blind trials have shown it can do the job, says
Shifren. "The nice thing is that it is a pharmacy-grade product designed for women. So
there are a lot of data on safety and efficacy."
The drawback is that the drug is a fixed dose of a
combination of estrogen and androgen. Women who may not need estrogen for hot
flashes may
not want to use the product.
"Estratest would be a very appropriate therapy for surgically
menopausal women who, after surgery, notice hot flashes and a decrease in
[sexual] desire," says Shifren.
Leiblum points out that Estratest and other drugs, while
useful for some women, are not cure-alls for libido. "None of these [drugs] are
probably going to be useful on their own," she says. "They all need to be seen as a
multifaceted approach to both assessment and
intervention."
Like all estrogens, the hormone may increase the risk of
heart attack, stroke, breast cancer, endometrial cancer, and blood clots in the
lungs or legs. Androgens can increase risk of liver cancer, and cause masculinizing
effects in women.
Wellbutrin
There is some evidence that the antidepressant drug, Wellbutrin, may
be able to boost women's libido.
In
a 12-week preliminary study of 66 women most of who were not
menopausal, 39% reported being satisfied with their levels of sexual
desire. Harry Croft, MD, a psychiatrist and sex therapist based in
San Antonio, reported the results of the study at the 2000 American
Psychiatric Association meeting.
Experts say they are not aware of any large studies on Wellbutrin and
sexual desire. But they aren't surprised that the drug may have some
effect on women's libido.
"What happens sometimes is that people's sex drive goes up, because
their depression is treated," says Koehler, noting that depression is
often accompanied by lower sex drive. "So it may not be
the Wellbutrin itself [that works]; it might be the feeling of being less depressed
that is causing the increased sex drive."
None of the women in Croft's study was depressed when the trial
began, but all had trouble becoming aroused or having orgasms.
Sometimes, a change in antidepressant drugs may help boost libido.
SSRI-type medications such as Prozac and Zoloft are known to
interfere with sexual desire. If a person switches from SSRI-type
antidepressants to Wellbutrin, there may be an increase in sexual desire,
because the others may be diminishing it, says Carol Rinkleib Ellison, PhD, a psychologist and author of Women's Sexualities.
On the other hand, Ellison says Wellbutrin could have the opposite
effect of dampening desire. "People are really individual in how they
respond to these medications," she says.
Herbal Remedies
With names like Lioness, Xzite, and Rekindle, dozens of nutritional
supplements line drugstore shelves with promises to enhance women's
libido. Some of them even have an eye-opening price tag to go with
claims. The daily supplement Avlimil, for instance, costs $324-$360
for a one-year supply.
Do
any of them work?
Whipple says she knows of only two dietary supplements for sexual
dysfunction that have been studied in double-blind, placebo- controlled trials: ArginMax and Zestra. The ArginMax trial looked at the
supplement's effect on sexual desire, while the Zestra study
looked at its effect on sexual arousal (libido is intact, but the
woman has trouble becoming or maintaining aroused).
ArginMax appeared to not only have a positive effect on women's
libido, but also showed satisfaction with sex lives -- an important, but
often ignored factor, says Whipple.
Polan was one of the researchers involved in the studies on ArginMax.
She says the supplement is safe for women to try on their own, but
she still recommends that they first check in with their
physicians.
"You don't want to miss what a doctor may pick up," says Polan. "You
want to make sure there is not some organic, or metabolic, or
physical reason for [the lack of sexual desire]."
Plus, it is important to make sure that herbal ingredients don't
negatively interact with any medications you may be taking, says Whipple.
For example, ArginMax contains gingko, which can promote
bleeding. It is not an ingredient that would mix well with blood thinners such
as aspirin or Coumadin.
Leiblum further warns that the FDA doesn't regulate natural
ingredients. "Women may be getting very high levels, or very low levels, or
totally zero levels of these supposed herbs."
Instead of looking at herbal remedies for lost libido, she recommends
taking self- inventory. "It's more important to try to figure out why
you lost [your libido], instead of trying to find a quick fix."
Looking Within
Changes in lifestyle, attitude, and relationships may not be bought
in drugstores, but experts say they hold keys to unlocking libido woes.
"For women, sex drive is critically dependent on being healthy and
really feeling good about a relationship. There will never be anything that
we'll be able to pull out of our medicine cabinet that
will be more important than those two things," says Shifren.
Part of being physically and emotionally healthy is having a sensible
dose of realism. It's normal to have low libido, says Ellison. In fact, she
says it's unrealistic to expect to feel a burst of
desire all the time, as shown on TV.
In real life, where people are in long-term, one-on-one relationships
with jobs, commutes, and kids, she says sexual drive isn't always
present.
Instead of looking for libido, Ellison recommends creating
opportunities to make time together special. "Maybe what you need to look for
is a way to be more interested in your partner," she
says.
Looking Within continued...
Taking part in enjoyable activities such as walking with a partner,
listening to music, having a glass of wine, taking a bath, or reading a
romance novel can also help put women in the mood for sex.
These activities can help women shift into their "sex self" from their role as
mother, wife, employer, or employee, says Ellison.
It would also help women to be more pleasure-oriented rather than
goal-oriented with sex. "Right now we have women fitting into a male
linear model of sexual response: desire, arousal, and
orgasm. But women don't work that way," says Whipple. "Sometimes holding
someone's hand and being held and kissed is all
[women] want, and it feels good. So enjoy that. Enjoy what you enjoy."
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