Photograph courtesy Amy Brenner, M.D.
Daisy Camden figured it was an inevitable drawback to a longtime marriage. “I’d lost all interest in sex,” she says. “Like 100 percent.” Conflict ensued between the Hyde Park mother of two (whose name has been changed for privacy) and her husband—the two wanted to restore her libido, but didn’t know where to start. Commiserating with a friend, also middle-aged, Camden came to understand that menopause was likely the buzzkill—not a lack of romantic interest. “No one had ever told me about that before,” she says.
In menopause, plunging levels of the hormones estrogen, progesterone, and testosterone can lead to a host of unpleasant, sometime debilitating conditions: hot flashes, low libido, insomnia, brain fog, moodiness, general aches and pains, vaginal dryness, and difficulty reaching orgasm. Hormone replacement therapy—chemical replicas of what the body makes naturally—became available in the early 1940s to combat the symptoms. Yet HRT remains maligned in some quarters due to decades of conflicting research and persistent misinformation. Even with the rise of bioidentical hormones, which mirror what the body produces naturally, outdated beliefs remain that HRT causes heart disease or even cancer. Prescribing guidelines continue to evolve.
A combination of synthetic estrogen and progesterone—in cream, patch, or pill form—is the traditional course of HRT treatment. Testosterone has also been available to women for decades but, despite conclusive evidence it enhances libido, has been much more rarely prescribed and still hasn’t received U.S. Food and Drug Administration approval. Its use for women remains off-label and isn’t covered by health insurance in the U.S., as it is in Australia, the U.K., and other countries. Meanwhile, erectile dysfunction meds like Viagra as well as testosterone therapy for men are common and usually covered by insurance.
Testosterone is not a “male” hormone; men simply have more of it. Both men and women produce all three hormones. Estrogen is a chemical trigger for changes in a woman’s body, especially during puberty and adulthood. Progesterone prepares the body for pregnancy and helps regulate periods. In men, estrogen and progesterone help regulate fertility, bone health, and brain function.
Testosterone, produced in women’s ovaries and adrenal glands, promotes energy, builds muscle, sharpens focus, and, yes, boosts sex drive. “When women are younger they make way more testosterone than estrogen,” says Amy Brenner, M.D., an OB/GYN whose practice in Mason does such a booming HRT business, including testosterone therapy, that it opened second and third locations last year in Kenwood and Centerville. The amount of testosterone women produce falls precipitously over time.
“There’s been a big movement toward testosterone therapy in the last couple of years,” says Kacey Kersting, a nurse practitioner. Of her HRT patients, 75 percent are on testosterone. Kate Winslet and Halle Berry have lauded the hormone in recent podcast interviews. Influencers, including doctors on TikTok and Instagram, are informing their followers about it. Even as the FDA drags its heels, more medical practices are offering it to meet the increase in demand.
Camden had to have her natural level of testosterone tested as part of her treatment, and it was at 0 percent. She opted for the hormone in pellet form (implanted into the backside) over creams or injections. It was a revelation. “It got my libido to where I wanted it to be but also had added benefits, like a boost in energy and completely eliminating my hot flashes, that I wasn’t expecting,” she says. “I was up and moving more and felt upbeat. It’s a mood lift.”
Testosterone’s “feel-good” reputation has proven to be a double-edged sword; anecdotally, many women swear by the perky, happy factor, but the medical community isn’t so sure. Two studies in 2019 concluded the therapy has no effect on mood or cognition. Meanwhile, the International Society for the Study of Women’s Sexual Health advises against the pellets, many of which are made in compounding pharmacies not regulated by the FDA.
The problem is not with the hormone itself or necessarily its delivery method, Brenner counters, but with the dosage, which must be carefully calibrated. “Testosterone has been vilified because a lot of providers think, If some is good, more is better,” she says. “A lot of practitioners overdose patients, and there are unwanted side effects. You have to find the Goldilocks spot.”
Kersting concurs, saying, “Medi-spas are giving women too much. But if you keep women in the goal zone, there are pretty much zero cons, except cost.”
As for Camden, she trusts Kersting, her science-obsessed provider. “Kacey started me on a very low dose and then increased it once,” says Camden. “It’s worked out perfectly. There’s a slow decrease over that 14-week period. I don’t lose desire any more, but if I went another couple of weeks [without another dose] I probably would.”
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