Revving Up Women's Sex Drive
Will there ever be a 'Viagra' for women?
There is one FDA-approved androgen (male hormone) on the market
for women. Estratest is a combination of oral estrogen and testosterone.
Although the product is only approved to treat
estrogen-resistant hot flashes, it has been used "off-label" by doctors and
patients. Off-label use means physicians prescribe drugs for a purpose other
than what they are approved for.
Estratest has not been approved to improve sexual desire in
menopausal women, but double-blind trials have shown it can do the job, says
Shifren. "The nice thing is that it is a pharmacy-grade product designed for
women. So there are a lot of data on safety and efficacy."
The drawback is that the drug is a fixed dose of a combination
of estrogen and androgen. Women who may not need estrogen for hot flashes may
not want to use the product.
"Estratest would be a very appropriate therapy for surgically
menopausal women who, after surgery, notice hot flashes and a decrease in
[sexual] desire," says Shifren.
Leiblum points out that Estratest and other drugs, while useful
for some women, are not cure-alls for libido. "None of these [drugs] are
probably going to be useful on their own," she says. "They all need to be seen
as a multifaceted approach to both assessment and intervention."
Like all estrogens, the hormone may increase the risk of heart
attack, stroke, breast cancer, endometrial cancer, and blood clots in the lungs
or legs. Androgens can increase risk of liver cancer, and cause masculinizing
effects in women.
There is some evidence that the antidepressant drug,
Wellbutrin, may be able to boost women's libido.
In a 12-week preliminary study of 66 women most of who were not
menopausal, 39% reported being satisfied with their levels of sexual desire.
Harry Croft, MD, a psychiatrist and sex therapist based in San Antonio,
reported the results of the study at the 2000 American Psychiatric Association
Experts say they are not aware of any large studies on
Wellbutrin and sexual desire. But they aren't surprised that the drug may have
some effect on women's libido.
"What happens sometimes is that people's sex drive goes up,
because their depression is treated," says Koehler, noting that depression is
often accompanied by lower sex drive. "So it may not be the Wellbutrin itself
[that works]; it might be the feeling of being less depressed that is causing
the increased sex drive."
None of the women in Croft's study was depressed when the trial
began, but all had trouble becoming aroused or having orgasms.
Sometimes, a change in antidepressant drugs may help boost
libido. SSRI-type medications such as Prozac and Zoloft are known to interfere
with sexual desire. If a person switches from SSRI-type antidepressants to
Wellbutrin, there may be an increase in sexual desire, because the others may
be diminishing it, says Carol Rinkleib Ellison, PhD, a psychologist and author
of Women's Sexualities.
On the other hand, Ellison says Wellbutrin could have the
opposite effect of dampening desire. "People are really individual in how they
respond to these medications," she says.