As women navigate through menopause, many may experience a decline in their libido, leading to concerns about their sexual wellbeing and overall quality of life. While it is tempting to assume that testosterone is the missing ingredient in addressing this issue, it is crucial to understand the intricate relationship between hormones, particularly testosterone and oestrogen, and why testosterone isn’t always the first solution.
It is a more complex consideration drawing on the importance of maximising oestrogen levels, the non-linear relationship between libido and testosterone, psychosexual aspects of low libido, as well as understanding the potential benefits and risks associated with testosterone supplementation in women during menopause.
The role of oestrogen in sexual wellbeing
Contrary to popular belief, it is important to focus on maximising oestrogen levels before considering testosterone as a solution for low libido during menopause. Testosterone, when administered to women, is often converted to oestrogen by the aromatase enzyme. Therefore, ensuring optimal oestrogen levels is essential for the proper functioning of the female reproductive system. Insufficient oestrogen can lead to genitourinary syndrome of menopause (GSM), sometimes called vaginal atrophy, which may not always exhibit noticeable symptoms but can still impact libido.
Read our article Don’t be embarrassed: A guide to genitourinary syndrome of menopause for more information on this subject.
The brain responds to this oestrogen deficiency by downregulating testosterone production, further reducing libido. Vaginal oestrogen pessaries can help alleviate the symptoms of GSM and contribute to an improvement in libido.
Testosterone’s complex relationship with libido
Testosterone plays a complex role in female sexual function; it is produced in the ovaries and the adrenal glands. While testosterone is commonly associated with libido, the relationship between testosterone levels and sexual desire is non-linear. Women can experience high levels of testosterone and still have a low libido, just as they can have low testosterone levels and a high libido. This means that other factors, such as psychological and emotional aspects, can contribute to sexual desire.
Why psychosexual support matters as much as hormones
Low libido during menopause is not solely a hormonal issue. Psychosexual factors, including stress, anxiety and relationship dynamics, can profoundly impact sexual desire. Addressing these aspects is crucial in resolving libido-related concerns. Counselling and therapy can provide women with the tools to explore their emotions, enhance communication within their relationships and regain sexual satisfaction. Combining psychological support with hormone optimisation can give more comprehensive results when addressing loss of libido.
“Low libido during menopause is not solely a hormonal issue. Psychosexual factors can profoundly impact sexual desire.”
Debunking myths around menopause and hormones
It is a common misconception that women lose three hormones at menopause – oestrogen, progesterone and testosterone – and that HRT only focuses on replacing the first two. In reality, women experience a more intricate hormonal transition. HRT aims to restore the overall hormonal balance disrupted during menopause, considering multiple hormones and their interplay.
The risks of testosterone therapy for women
While testosterone supplementation can have benefits, it must be carefully monitored. Elevated testosterone levels in women can lead to adverse effects such as acne, hirsutism (excessive hair growth), voice changes and even cardiovascular risks. Blood tests should be completed before starting any treatment involving testosterone and ongoing monitoring is essential to avoid potential complications.
Research and new findings
Recent studies have shed some light that there may be potential benefits of testosterone supplementation beyond libido improvement. However, more research is needed to fully understand the effects of testosterone on joint aches and pains, brain fog and low mood levels at menopause.
Following safe guidelines for prescribing testosterone
When addressing loss of libido during menopause, it is essential that your doctor follows prescribing guidelines outlined by organisations like the National Institute for Health and Care Excellence (NICE). These guidelines emphasise the importance of maximising oestrogen levels before considering testosterone supplementation.
Psychological support, such as counselling, should be integrated into treatment plans to address the psychosexual aspects of low libido. Regular monitoring of hormone levels, particularly testosterone, is crucial to ensure optimal results while minimising risks.
By following these guidelines, your healthcare professional can provide a comprehensive approach to addressing your loss of libido at menopause, considering your individual needs and optimising your overall wellbeing as part of your personalised treatment plan.
The article was originally published on The Menopause Consortium who are a registered stakeholder in NICE, and who remain vigilant in monitoring research and findings to consistently offer up-to-date, evidence-based information to support women during menopause.
