Published in The Times March 6th 2004
Prozac isn’t the only deterrent to women’s libido. An international conference in Florence heard last week that for years doctors have been “delinquent” in their approach to female sexuality overall. The speaker was none other than the multiply -eminent James A Simon MD, Professor of Obstetrics and Gynecology at the George Washington University, Washington DC.
For example, he said that attempts from the 1960s onwards to provide safe hormonal contraception and effective replacement hormones for the menopause ignored two absolutely startling facts. The first is that women have more testosterone in their bodies by far than oestrogen. Second, by basing all the original hormone therapies on additional oestrogen, while ignoring the role of testosterone, doctors were effectively assisting men to enjoy better lubricated penetration but condemning at least one woman in ten to a loss of sexual drive.
“Oestrogen replacement therapy reverses symptoms of vaginal dryness and atrophy, which is all very well and nice for husbands and partners yet was never going to make any positive difference to women’s level of sexual interest. Oestrogens were oversold as a panacea. We were so delinquent in our investigations that 80% of the studies into this subject in the entire world can be reviewed in 30 minutes”.
Did doctors do this on purpose? No, but their Victorian thinking prevented them from recognising the essential implications of this approach for female patients. It had been established for nearly 40 years that testosterone plays a critical role in the formation of sexual drive and desire in BOTH sexes. Researchers knew that raising the level of oestrogen in a woman’s body automatically served to increase the level of SHBG (sex hormone binding globulin). This had the effect of reducing the amount of ‘free’ testosterone in her bloodstream and in all too many cases this resulted in a net loss of drive.
“With the contraceptive Pill, I see cases every week of really responsible young women of 25 who know they want to embark on a major love affair. They come for their AIDS test; they start taking oral contraception only to lose all interest in lovemaking. Dressed up to the nines but nowhere to go”, says Professor Simon.
So much for the fabled hints by people like Teresa Gorman MP that oestrogen-based HRT was actually a pocket rocket when the truth for one woman in ten was completely the opposite. It is equally fascinating that the deficiencies of a strongly-promoted hormonal treatment like HRT only became easily-admitted once a new product loomed on the horizon.
Cue the testosterone patch for women likely to be launched by Procter and Gamble later this year or next year under the name ‘Intrinsa’. But will women consumers buy the hype? We know that Pfizer have abandoned plans to manufacture female Viagra in the face of women’s steadfast refusal to function like men. If you want women to grow more passionate, they discovered, it isn’t enough to raise their genital blood flow they also need to know the name of the man on the other end of the penis in question.
There are also new fears about the risk of strokes on standard HRT.But testosterone is a really interesting compound and the evidence after surgical menopause does indicate that for about ten per cent of women replacing this hormone can prevent not only an acute loss of libido it can increase lean muscle mass and will compensate for a lack of drive in the very engine room of life.
As the highly enthusiastic Dr Alessandra Graziottin of the University of Florence puts it: “Androgens (testosterone in particular) are responsible for our ‘seeking’ behaviour, the push drive. If your androgen levels fall, you need three times the gym exercise to get the same muscle mass. Sexually it puts the lights back on. With this therapy, women recover not only their self-confidence they even get better at parking cars…”