Tuesday, August 03, 2004

How's Your Sex Drive?

I mentioned before that sex drive (libido) in reproductive-age women is a complex issue. Many factors play a role: current health, physical and social environment, past sexual experiences, hormone levels, cultural and educational background, and relationship with partner. In particular, the role of testosterone is not well-defined. [Women produce a number of male-type hormones (androgens), like testosterone, both in their ovaries, as well as their adrenal glands. (The adrenals are two small glands that sit atop the kidneys.)]

We know that in men (and some postmenopausal women) low levels of androgens create a deficient state called hypoandrogenism, we know the problems associated with this state (e.g., low sex drive), and we know how to treat it (testosterone supplementation). However, in women it's not clear that such a low androgen state even exists. So, before you apply that testosterone patch [I'm joking, please don't do that!] I found a very good article for you to read. In it, two experts discuss the evidence for the pro and con positions, and conclude:


As research continues in this area, especially in the area of assays that accurately measure free T [Testosterone] at low levels, our understanding of androgen insufficiency in woman will broaden.


In summary, FAI [Female Androgen Insensitivity syndrome] is poorly defined and characterized. There are no clear diagnostic criteria. Therapy with androgen has yet to be proved safe and effective.

In addition to the substance of the article, pay particular attention to its form. Why? It will help you learn how to evaluate medical information. This is very important to remember: in order for you to make a truly informed health decision you have to 1) have complete and correct information, and 2) be able to evaluate that information. I plan a more detail post on this topic, but for now look at the article and notice that:

--there are no sensational titles

--there's no inflammatory language

--there are no personal/moral/social pronouncements

--the article is well-referenced

Update: Here's a case study of a woman with low sex drive. Although of limited practical use--patient is 51 years old and perimenopausal--the discussion does offer an interesting insight:

Anne, age 51, presents with complaints of depressed mood and low libido. She says she has become irritable and snaps easily at her 2 children and her husband. She has no interest in sex, no urge to masturbate, and has had no sexual intercourse for 6 months.

Anne also complains of fatigue, dry hair and skin, warm flushes, and painful joints.

She has no personal or family history of depression. She is not suicidal but she "really doesn't want to live anymore if this is it."

Anne says her husband is angry about the lack of sexual intercourse, and she feels the stress in their marriage. She also is worrying about her children leaving for college and about her mother's ill health.

She scores 20 on the Beck Depression Inventory, which indicates that she has mild to moderate depression. Her menstrual periods remain regular, but her cycle has shortened from 29 to 24 days. She reports that some hot flashes wake her at night, and says she hasn't had a good night's sleep in months.


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