by Iver Juster, MD Gary Schubach, Ed.D. Patricia Taylor, Ph.D.
Proctor & Gamble is about to release a new drug, Intrinsa©, which is intended for women suffering from a loss of sexual desire as a result of medical or surgical menopause. The drug is being developed as a skin patch containing testosterone, a hormone that affects sexual desire in women. While there is considerable evidence that testosterone can impact sexual desire after menopause1-3, we don’t accept the idea that female sexual desire is totally or – even mostly – about hormones. A growing body of evidence – as well as most people’s personal experience – tells us that emotional connection and good communication play key roles. Our fear is that Proctor & Gamble is about to spend $100,000,000 to convince all women that the cure for low sexual desire is Intrinsa©.
We fear that, since most people hope this is true, Intrinsa© use will lead to preventable disappointments.
Let’s start with some hormone science. Studies do show that testosterone can make a big difference for women who have had their ovaries removed. However, it won’t do much good for post-menopausal women who don’t have low free testosterone levels. While I’m sure Procter and Gamble is not deliberately promoting the idea that sexual desire is about hormones and needs drugs to fix it, they are certainly capitalizing on the increasing public hope that sexual desire is basically a medical issue and can be fixed with drugs or surgery, and if not that, then a new partner. Because of this, people will take drugs or get surgery and not deal with issues of turn on, communication, and personal transformation. The most one could hope for is a return to the previous state of affairs, definitely an improvement, but, for most people in long term relationships, the previous state of affairs wasn’t all that great.
In terms of using testosterone to stimulate sexual desire in women, the long-term effects are unknown and might prove to be dangerous. After years of promoting HRT (hormone replacement therapy – estrogen or estrogen/progesterone) to millions of women, United States health authorities have stopped clinical trials of various forms of HRT because of the dangerous nature of their findings4, 5 and the North American Menopause Society has recommended that these hormones not be prescribed except for short-term relief of severe symptoms of menopause6. In the case of declining levels of testosterone, just because a hormone is declining from levels achieved at age 25 doesn’t imply that it should (in terms of healthy outcomes) be replaced back to those levels (or even higher).
The lessons from estrogen and estrogen/progesterone are quite relevant in this regard. It may be years before we know about the safety of testosterone replacement, especially after natural menopause. The first good studies will likely be completed after at least five years of use of the drug. These initial studies will likely be simple case-control studies (find two groups of people; one group of ‘cases’ has some disease you want to study like heart disease or some kind of cancer; the other group is a ‘control’ with those who don’t have the disease; then you look back to get the odds of ‘exposure,’ to testosterone.). Early case-control studies of estrogen and estrogen/progesterone suggested that these medications were beneficial or at least not harmful for preventing heart disease7 and in combination even prevented uterine cancer8. Later more rigorous studies called ‘retrospective cohort studies’ often agreed with the case-control studies9. It was only when we had ‘randomized prospective trials’ that the truth (even though suggested by a few of the earlier studies) emerged10, 11. It could be at least ten years until we get to that point with testosterone, if indeed anyone even decides to study it.
When Intrinsa© is released, with its $100 million ad campaign, I strongly suspect that there will be enormous patient pressure on doctors to prescribe Intrinsa© for all women who perceive themselves to have low sexual desire, regardless of their age or reproductive status. In order to be medically responsible, Intrinsa© should not be prescribed for any woman until tests have been performed to determine whether she really has low testosterone levels. If the testosterone levels are low, my recommendation would be to replace testosterone at the lowest level of free testosterone in range for women in their late 30s; get tested for cancer and liver function as well as blood counts a couple of times a year; get screened for cancer as recommended; and live an extremely healthy lifestyle. And be aware that women using this patch are part of an uncontrolled experiment.
Even for women whose biochemical profile and history make a strong case for the patch, it’s only a part of improving her sex life. We believe that the emotional and psychological components are still the most important aspects of female sexual desire. And let’s distinguish between sexual drive and sexual desire. One can have profound levels of desire – for emotional connection, physical contact, and erotic arousal and adventure – with minimal levels of drive. We are not born knowing how to be sublime lovers, but the good news is that that can be learned, as a reflection of love and caring for another human being.
Sadly, in our culture, boys and girls are not given good information about human sexuality so as to be able to craft a rewarding sex life. We are a society full of contradictions about sex and young people are coming to sexual maturity full of fears and confusion and misunderstandings. Men are not taught how to pleasurably stimulate a woman sexually and function with beliefs that intercourse is the ultimate sexual goal and is the way to sexual satisfaction for both partners. Yet study after study shows how dissatisfied women are with intercourse alone as a path to sexual gratification, and how women’s sexual response cycles are usually much longer than men’s. It would make sense to be teaching men and women lovemaking techniques that will allow for – even celebrate – the differences in male and female physiology.
Just as Viagra has turned out not to be the universal panacea for male sexual issues, Intrinsa© will not be the “magic pill” that resolves the problem of female low sexual desire, either pre- or post-menopause. The human issues, how to love and care for another human being and be aware of and satisfy their emotional as well as physical needs, are still the most important factors.
Intrinsa© is a registered trademark of Procter & Gamble
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