by Karla Jennings
When Joan's muscle aches - the result of an early hysterectomy - became disabling, she asked her doctor for help. He prescribed the male hormone testosterone. But after just a few weeks on the medication, Joan discovered an astonishing side effect: Testosterone not only relieved her pain but it also boosted her once-normal libido to an X-rated level.
"Now I know what it's like to be a nymphomaniac," she says. "I'd walk down the street and wonder what everybody looked like naked ... what they'd be like." But her sexual intensity had a down side. Both she and her husband found it unnerving. "He couldn't keep up with me," says Joan. She couldn't even keep up with herself. "It became an inconvenience," she confesses.
"If you could turn it on just on Friday nights, it would be nice. But to think about sex all the time, every hour .... I didn't enjoy it." She also gained weight, and fuzz appeared on her upper lip. These side effects - typical with hormonal therapy - frustrated her, so she discontinued the treatment.
"Now I'm back to being a perfectly normal person, which is fine with me," she says. Joan is one of relatively few American women who've experienced the sexual tidal wave that testosterone can unleash. Despite scores of studies - mostly in Canada and England - which show that this androgen can be a clinical aphrodisiac for women with low or nonexistent libido, its role in the treatment of sexual dysfunction is still controversial.
Why are American doctors so reluctant to prescribe testosterone? "Ignorance and fear," suggests Lawrence S. Sonkin, M.D., an endocrinologist at the New York Hospital-Cornell Medical Center, in New York City. Some physicians mistrust testosterone because early research wasn't conducted with the elaborate double-blind, randomized methods required today, says Dr. Sonkin. But what really frightened doctors were reports that surfaced in the midseventies claiming that women who took the hormone estrogen - in birth- control pills, for example - were at greater risk of developing uterine and breast cancer.
"We began to be very frightened about hormones," he says. The controversy continues. A recent study of 120,000 women who took estrogen for extended periods of time concluded that they had a slightly greater risk of developing breast cancer than women who didn't. As a result, many physicians remain ill at ease about prescribing any hormones - including testosterone. Also troubling are dosage requirements. Testosterone must be administered with precision and finesse, and almost always in conjunction with estrogen. Its potential side effects may also have some bearing on the issue.
They include facial-hair growth, weight gain, an uncontrollable libido, lowered voice, an increase in low-density lipids (bad cholesterol), and, though less common, a rare form of jaundice. Yet some women, particularly those who've experienced early menopause and those with low or nonexistent sex drives, are willing to endure the side effects in order to reclaim their sexuality - to feel once again the longings that testosterone therapy may provide.
Hormones: Sexual Chemistry At one time or another, we've all blamed something on "raging hormones" - a bad case of acne, a bout with depression, a particularly explicit sexual fantasy. But what exactly are hormones? They're the body chemicals that regulate everything from strength and growth to moods and sexual development. The female sex hormone is estrogen. It's produced by the ovaries, and without it, a girl can't reach sexual maturity (she won't ovulate or develop breasts).
Testosterone is the supreme pilot of male sexuality. It's produced in the testicles, and without it, a boy can't reach his sexual maturity (his voice won't deepen, and he won't grow facial or body hair). Women, too, have a natural supply of testosterone, but in much smaller quantities. On average, men have about ten times more testosterone than women (the female body makes small amounts of it in the ovaries and adrenals), but levels do vary. Male blood-testosterone levels range from 300 to 1,200 nanograms per deciliter, while the female equivalent ranges from 15 to 100. As women, our battle with the effects of low testosterone doesn't typically begin until after menopause, when our bodies' natural hormone supplies diminish. However, two surgical procedures - the bilateral oophorectomy (removal of both ovaries and adrenals) and the hysterectomy (removal of the uterus) - will trigger early menopause in women of any age.
These operations, often necessary to remedy certain reproductive cancers and such benign - but serious -conditions as ovarian cysts and endometriosis, can extinguish a woman's libido and shatter her sexual self-image. Yet research into the important role testosterone plays in most women's sexuality was virtually nonexistent until the 1930s, when George N. Papanicolaou - who invented the Pap test for cervical cancer - began treating his menopausal and premenopausal patients with testosterone-estrogen combinations. In research published in 1938, he and his colleagues documented that menopausal women receiving testosterone had enlarged clitorises, lowered voices, and recharged sex drives.
With half a century of research under their belts since then, you'd think scientists could agree whether testosterone can restore a woman's libido. Not so. Researchers still argue about whether testosterone helps women regain their sex drives or simply acts as a placebo, solving a problem that's really all in their heads. Treatment with a Capital "T" New evidence increasingly suggests, however, that testosterone can enrich a woman's sexuality. One researcher who's convinced the hormone works is psychologist Barbara B. Sherwin, of McGill University in Montreal, who, over the past decade, has conducted meticulous studies on the effects of testosterone on women. She believes such treatment has been virtually ignored by the medical community because of age-old prejudices about female sexuality. "If women complain of having reduced sexual desire, the prevailing attitude has been, 'So what?'" says Sherwin. "But if men do, it's considered a serious issue."
Through her efforts - as well as those of other pioneering hormone researchers - those attitudes are changing. Sherwin's protocol is fairly simple. Her research volunteers are women who've undergone hysterectomies, bilateral oophorectomies, or both, for reasons other than cancer (such patients are excluded because giving them hormones could worsen their conditions). Sherwin gives them injections of estrogen, an estrogen- testosterone combination, or a placebo, and has them monitor their sexual activity. The result? She's found that women whose libidos dropped after surgically induced menopause experience increases in sexual desire, sexual arousal, and sexual fantasies when they receive the estrogen-testosterone preparation but not when given the estrogen alone.
When the estrogen- testosterone injections are secretly replaced with a placebo, the women experience decreases in all three measurements of libido. New York City endocrinologist Lawrence Sonkin is another proponent of low- dose testosterone treatment. He's prescribed the medication - in weekly doses of ten to twenty milligrams - for about thirty women whose symptoms have included lost libido, depression, weight loss, low estrogen levels, and postmenopausal facial and muscular pain.
Most responses to the testosterone therapy, says Dr. Sonkin, have been dramatic. How dramatic? Sometimes too much so, Dr. Sonkin admits. "I've had husbands object to the frequency of their wives' sexual demands," he says. "On the other hand, some husbands are very happy about it!" The "Male" in Female Remember, all women have naturally occurring testosterone in their bodies.
Within the past decade, this physiological variable has come under close scrutiny by the American medical community. In one study, Sandra Leiblum, a professor of clinical psychiatry and codirector of the sexual counseling service at the UMDNJ-Robert Wood Johnson Medical School in Piscataway, New Jersey, studied fifty-two postmenopausal women and found that the more sexually active ones had higher testosterone levels than the rest.
They also were an average of eighteen pounds lighter, had higher incomes, and reported engaging in more frequent physical affection and more various sexual activity with their partners. But did higher testos- terone levels drive them to have more sex, or vice versa? "That's a good question," says Leiblum. The Aggression Factor One of the greatest mysteries surrounding testosterone is how it affects the female personality.
Even the testosterone we're exposed to while in the womb might help mold the women we become, suggests a study conducted by psychobiologist June Reinisch, director of Indiana University's Kinsey Institute for Research in Sex, Gender, and Reproduction. She studied seventeen girls and eight boys whose mothers took drugs containing synthetic progestins (chemicals closely resembling testosterone) during pregnancy to prevent miscarriage. Reinisch gave these children written aggression tests and then compared the results to those of same-sex siblings who weren't exposed to progestins in the womb.
The exposed children scored higher in aggression than their siblings. How young girls score on psychological tests can't, with any certainty, predict how they, as grown women, will react to life's problems and challenges. But other studies have suggested that natural testosterone levels can have an effect on a woman's basic personality. For example, Patricia Schreiner-Engel, a psychologist and endocrine researcher at New York City's Mount Sinai Hospital School of Medicine, studied the monthly testosterone fluctuations of healthy heterosexual women. She found that women with naturally high testosterone levels (more than fifty-four nanograms per deciliter) reported less satisfaction with their sexual relationships but were more assertive and tended to have more competitive careers. "The high- testosterone women seemed to be more active," she says.
On the other hand, the lower-testosterone women (those with less than thirty-six nanograms per deciliter) were, according to Schreiner-Engel, more passive, more accepting, and tended to exercise more and suffer less-severe menstrual cramps. Both groups also exhibited a marked difference in sexual arousal: The high- testosterone women got aroused most just before and after menstruation, while those with lower levels tended to have steadier rates of arousability throughout their cycles, says Schreiner-Engel. This doesn't, however, necessarily affect how often a woman has sex, she explains, because arousal is what happens after sexual stim-ulation begins.
No Magic Bullet Although it appears that testosterone plays a vital role in female sexuality, it's still only one of many influences on a woman's life. Someone who's overwhelmed by sexual dysfunction and thinks that testosterone will be her cure-all is forgetting that hormones, psychology and sex all dance together in an intricate quadrille, not a simple two-step. Even its greatest advocates argue that testosterone is not a panacea. "Everyone wants the magic bullet, everyone wants something the quick-and- easy way," says UMDNJ's Sandra Leiblum. "My experience is that it doesn't work that way.
It would be terribly destructive if women rushed to their gynecologists for testosterone." Yet for the woman frustrated by a lack of libido or by low hormone levels, testosterone therapy could restore her sexual happiness. And after decades of uncertainty and ignorance, doctors are now seeking advice about testosterone from experts like Barbara Sherwin. "Judging from the amount of mail I get from women and physicians, there's a lot of renewed interest," Sherwin says. "Women are finally demanding the best treatment they can get."