Testosterone “Replacement” for Women

Phthalates (plasticizers) are hormone-disrupting chemicals in PVC plastics that are blamed for a range of harmful health effects such as disruptions in genital and behavioral development in infants and children. Data show, for example, “incomplete virilization in male infants,” reduced “male-typical play” in adolescence, and in girls an earlier onset of puberty. In adults, phthalates can impair sex life, as I discuss in see.nf/phthalates.

In addition, they not only increase breast cancer risk, but can also impair testosterone production in men and reduce libido in women. Fasting studies show that we take in most phthalates through food, but we can achieve a similar decline if we eat a plant-based diet for a few days.

The highest levels are found in meat, fats, and dairy products. Poultry is consistently the most contaminated and in some cases reaches some of the highest levels ever reported. High meat and dairy consumption can exceed the tolerable daily intake set by the U. S. Consumer Product Safety Commission.

Even during total fasting, in a few cases peak urinary phthalate levels were found after showering, an indication of contamination from personal care products. This can be avoided by choosing unscented products, since phthalates are used as fragrance carriers. Children’s toys are now not allowed to exceed certain phthalate concentrations, but this does not apply to adult toys. Sex toys are often “jelly”-based, made of soft vinyl material stuffed with phthalates. Even if using water-based lubricants can reduce the transfer of phthalates 100-fold, such sex toys may work differently than intended.

Testosterone “Replacement” for Women

Testosterone and sexual desire go together—in men and in women. Women normally produce testosterone throughout their lives; even after menopause, the ovaries are still active. But testosterone levels decline over time—by 50 to about half. This is thought to be one cause of reduced libido (using the frequency of masturbation as a partner-independent indicator).

These days, “female androgen deficiency syndrome” is readily diagnosed, yet there is no evidence that testosterone “replacement” helps with mood swings, well-being, or hot flashes, or contributes to bone density, cardiovascular health, or metabolic health. The only evidence-based reason to try testosterone in postmenopausal women would be to treat reduced sexual desire if they suffer from it, but as I explain in see.nf/t4women, that is not enough for FDA approval, especially since nothing is known about long-term side effects. DHEA, which can be converted into testosterone in the body, does not significantly increase desire or sexual function, but there are natural ways to raise women’s testosterone levels: listening to music and not drinking peppermint tea.

Arousing Scents

What else can older women do to increase their sexual desire, if they want to? Aromatherapy may be able to help. In participants randomized to sniff lavender scent twice daily for 20 minutes for twelve weeks, menopausal complaints improved, and sexual desire also improved significantly compared to the control group, who smelled diluted milk. Neroli oil (bitter orange) worked even faster. Sniffing for just five minutes twice daily for five days led to a significant strengthening of sexual desire, even when the essential oil was diluted to a concentration of 0.1 percent. The comparison group smelled only the carrier oil (almond). However, placebo effects are difficult to rule out, since the controls were not matched for intensity. It would have been better if the study design had also taken synthetic scents into account, but the oils might still be worth a try.

Root Power: Ginseng, Maca, and Ashwagandha

What about other supplements, such as the three roots ginseng, maca, and ashwagandha? Details are available at see.nf/roots, but in principle ginseng flopped as far as female sexual dysfunction is concerned, even though a small study with about three quarters of a teaspoon of maca powder suggested some effect. Ashwagandha (derived from Sanskrit, from ashwa for “horse” and gandha for “smell,” because the root apparently has the “peculiar smell of a wet horse”) might also help, but cannot be recommended because isolated cases of liver damage occurred. What else could one expect from a plant that in English has the nickname poison gooseberry (“poison gooseberry”)?

Vaginal Moisturizers

Usually four or five years after the last period, about half of postmenopausal women suffer from what was formerly called vulvovaginal atrophy, though today it is referred to as genitourinary syndrome of menopause (GSM). The Vulvovaginal Atrophy Terminology Consensus Conference Panel of the North American Menopause Society decided that the term GSM was “more acceptable to the public.” The original term was in fact quite accurate, but the panel believed the word “atrophy” was “negatively connoted,” and the word “vagina” was “not acceptable for public discourse or the media in common usage.” The panel compared the name change to replacing the pejorative “impotence” with “erectile dysfunction.”

No matter what one calls the syndrome, it involves changes to the vulva (the external sex organ), the vagina (the birth canal), and the bladder, caused by menopausal changes in hormone levels. The result is vaginal dryness, burning, itching, and skin irritation, pain during intercourse, and postcoital bleeding, which stems from the vaginal lining being thinner. Possible urinary complaints are recurrent bladder infections and incontinence. Some women with mild GSM have no symptoms. In others, they can be so severe that intercourse becomes impossible and even sitting or wiping can cause discomfort. In a survey of thousands of women with GSM, 59 percent said their symptoms had “significantly reduced their enjoyment of sexual activity,” and 23 percent reported that the symptoms had adversely affected their “general enjoyment of life.”

While other menopausal complaints, such as hot flashes, usually subside over time, GSM symptoms tend to worsen. Unfortunately, women are rarely treated for it, even though safe and simple relief is available. First aid for mild to moderate vaginal dryness is provided by lubricants and moisturizing creams.

Lubricants are meant to reduce friction during sexual activity, whereas vaginal moisturizing creams are used daily or every two to three days as needed and mimic normal vaginal secretions, independent of sexual activity. Water-based lubricants do not stain and, compared to silicone-based lubricants, are less often associated with complaints such as discomfort or burning in the genital area.

What is the best vaginal moisturizing cream? In a head-to-head comparison, the expensive vaginal gel Replens, with supposedly “bioadhesive” ingredients, was pitted against a placebo gel made of hydroxyethylcellulose, which is found in products ten times cheaper, such as K-Y Jelly. After twelve weeks, the researchers found no difference. This “impressive” result led to the recommendation in a commentary in the Journal of the American Medical Association that, until new evidence emerges, “postmenopausal women with vulvovaginal complaints should buy the cheapest moisturizer or the cheapest lubricating gel they can get …”.