There have been volumes written about the widely experienced phenomenon, which often appears when women pass out of childbearing age into menopause, and seem to lose any interest in sex with their partners. It is almost as if there is a switch in the brain, which cuts off desire simply because it can’t lead to that most-wanted outcome of sex, which is a baby.
I started to experience this decline when I reached my own menopause, so I grabbed whatever material I could find to try to understand better and overcome this change. To my dismay, I found that whatever was out there was based mainly on guesswork from the author’s specialty. Most of what has been written has been pure speculation, because doctors couldn’t point to a specific biological process that gives rise to desire in the first place. It is such an ephemeral and emotional process, and is highly personal as well, varying from person to person and changing throughout their lives.
The diagnosis I got from my doctor referred to a condition called hypoactive sexual desire disorder, or HSDD for short. A quick search of this term taught me that HDSS is one of the most common sexual disorders, officially estimated to affect 10% of all women and 8% of all men. However, what I read was that the real numbers are bound to be significantly higher, because people are generally extremely reluctant to complain of problems in a delicate and highly personal area such as sexual desire. There’s also a distinct separation between how the disorder is viewed when it affects men and women. In the case of men, it is closely related to associated problems, like erectile dysfunction, which have been the subject of much more research and which are now part of the general public’s knowledge.
The “official” view of hypoactive sexual desire disorder (HSDD)
Like for most medical conditions, doctors have attached a label that describes this decline in libido in terms familiar to them. It may tell them and their colleagues what is wrong with the patient, but it slips under the radar for untrained people like me who are actually living with the symptoms. So, to decode “hypoactive sexual desire disorder” – “Hypoactive” means it’s working at lower than “normal” or expected levels. “Sexual desire” means interest in or desire to engage in some form of sex activity. And “disorder” means that it’s recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and established as a treatable clinical entity, characterized by a persistent lack of sexual desire causing significant personal distress. Therein lies a key fact. For doctors, this is a “mental disorder”, which strongly influences how they will interpret the symptoms and treat their patients.
For a bit more insight, I’m quoting from an article by Dr. Rachel Rubin, assistant Clinical Professor in Urology at Georgetown University, who is a board-certified urologist with a specialization in sexual medicine. Writing on the Contemporary ObGyn website in mid-May 2022, she said “there are a lot of misconceptions surrounding HSDD, mostly because we are not trained to think of it as a medical problem.“
What has been learned recently about the reduced interest in sex that comes with menopause? 
Thank goodness, science progresses in leaps and bounds. A finding by a group of researchers at UK public healthcare trusts and universities has turned a bright light on the whole question of HSDD, because they have found that there appears to be a form of top-down filtering going on the brains of both men and women with this disorder. In women who have been diagnosed as having HSDDr, areas of the brain that deal with desire are apparently suppressed by cognitive brain regions, where thinking and processing happen.
While this doesn’t sound like a great revelation, for women generally it can mean that the whole issue of lower levels of interest in sex is no longer such as emotional (or even hysterical) diagnosis, but one which doctors can start to investigate as a biological condition that is worth treating along more conventional lines, with the kinds of tools that they use to treat more common conditions.
What happens in women’s bodies when menopause sets in?
A cascade of changes sets in as women age past their time of fertility. It begins in the few years called perimenopause, when a woman starts to notice distinct changes in the regularity of her menstrual periods, experiencing sudden hot flashes, and sweating profusely at night. Along with fluctuations in her moods and personality, and possibly having a lowered level of interest in sex. There’s no telling in advance for how long this will last, and the way full menopause is defined is that it is finally in place when a woman has gone twelve full months without having a menstrual period.
The changes are caused by sharp drops in the levels of the three key hormones that drive the ovarian cycle, namely estrogen, progesterone, and testosterone. Without the normally high levels of estrogen, a woman can start to experience many unpleasant symptoms that weren’t related to her previous monthly cycles, such as more frequent urinary tract infections (UTIs), feelings of depression, mood swings, and fatigue. She can also have changes in her sexual activity, coming from an inability to engage with any pleasure in sex due to pain which comes from dryness in the vagina and vulva. Her breasts may become tender,
and she may experience frequent and intense hot flashes and night sweats.
There are also hidden changes that can have more serious long-term effects. Low levels of estrogen can cause decreased bone density (osteoporosis), which can eventually lead to easy fracturing in simple falls and bumps.
Apart from the changes in estrogen and its linked hormone progesterone, menopause brings with it changes in the levels of testosterone. Whereas testosterone is more commonly thought of as the “male hormone,”, it still is present in a woman’s body in low levels, and these drop further when menopause sets in, giving rise to loss of libido and interest in sex, lower level in her sense of well-being and changes in her body shape. There can also be emotional changes, such as constant fatigue, reduced levels of general motivation, general depression, and mood changes.
What treatments are there for estrogen depletion?
The standard treatment for the problems coming from depleted estrogen is hormone replacement therapy (HRT). Its effect is to boost the body’s levels of estrogen to close to normal, via oral medications like Duavee, Premarin, and Estrace. When the problem is more specific, like night sweats and hot flashes, a targeted treatment like Vezoah will usually be prescribed in preference to estrogen, which is more like a broad-spectrum approach.
What treatments are there for testosterone depletion?
Unlike for estrogen replacement, there are no oral medications to boost testosterone suitable for either women or men. This has been due to past experience when older formulations had severe side effects, damaging the livers of people who took tablets containing methyltestosterone.
The best available option is to deliver a dose of skin-absorbent testosterone through daily application of Androfeme cream, which contains a form of testosterone that is bioidentical to the testosterone produced by women’s ovaries. AndroFeme was developed by a high-tech pharma company in Australia specifically to treat postmenopausal women (or women who have had a total hysterectomy) who have lost interest in sex (HSDD).
How to prepare a dose of AndroFeme
Each AndroFeme delivery comes along with a syringe style measuring applicator in a sealed sleeve. The applicator is marked with 0.25 mL graduations for dosing accuracy. Doctors usually prescribe daily doses of 5 mg of testosterone, which means that measuring application must be filled up to the 0.5 mL mark.
AndroFeme should be used each day at the same time. If a dose is missed at the usual time, it should be applied as soon as this is realized, and the usual routine should then continue. However, if it is close to the time of the next dose, skip the missed dose and apply the next dose when scheduled.
Where is the best place to apply Androfeme?
The proper site of application is on clean, dry, healthy skin on either the upper outer thigh or high on the buttock. Don’t apply the cream to broken or damaged skin, or on the genital or other areas of the skin. Massage the cream gently into the area until it has been absorbed. This should take about 30 seconds.
Following the massage, it’s important to wash hands thoroughly with soap and water. Be careful not to allow a pregnant woman to come in contact with either the tube or applicator, or to touch any area of skin where a remnant of the cream could be transferred to them.
It is necessary to not swim, bathe or shower for at least four hours after application of the cream. For this reason, most doctors recommend that the best time to schedule application of the cream is a few hours before going to bed. However, care must be taken not to allow any bed linen to come into direct contact with the area where the cream was applied, so suitable night clothing must be worn and kept safe from being accidentally touched by anyone else.
How long does it take for the effects of AndroFeme to show?
It’s usually recommended that AndroFeme should be used for a minimum of three months to see if the medicine is beneficial. It may take one or two months for an improvement to be noticed. If symptoms that led to the prescription do not improve after six months, alternative treatments should be discussed.
Are there side effects to the use of AndroFeme?
As with all medications, there is the risk of some side effects. Doctors usually take into account the possible adverse effects, and will be prescribing AndroFeme when in their opinion the benefits to the patient’s well-being outweigh these potential side effects.
The less serious side effects of AndroFeme are hormone-related and can show up as acne and oily skin, increased body hair (particularly on the face), loss or thinning of head hair, or headaches. There can also be stomach-related effects, like abdominal bloating or constipation. If any of these are felt and they persist or get worse, talk to the prescribing doctor as aoon as possible.
There are some rare but potentially more serious side effects, such as a sudden allergic reaction (anaphylaxis) shortly after the first use of AndroFeme, producing symptoms like swelling of the face, tongue, or throat making it difficult to breathe or swallow, or there is wheezing, hives, rash, blistering, or peeling of the skin. Call a doctor or 911 right away, or go to an emergency room immediately.
Other serious side effects that require immediate attention or transfer to an emergency room include:
- Nausea and vomiting
- Yellowing of the skin and/or eyes (jaundice)
- Swelling of the ankles
- Weight gain
- Persistent headaches
- Deepening of the voice
- Changes in tissue of the breast
- Vaginal bleeding
- Enlargement of the clitoris.
If by accident a pre-menstrual woman used or came into contact with AndroFeme cream, her ovulation and menstrual periods may stop. A gynecologist should be contacted as soon as possible.
How well do doctors rate AndroFeme for safety?
Drugs produced for prescription in Australia have to satisfy extremely strict Government protocols for purity and safety. This makes AndroFeme at least as safe as any FDA-approved drug sold in the US.
Are there any long-term side effects coming from daily use of AndroFeme?
AndroFeme should only be used for a maximum of two years, and patients are meant to be in regular consultation with their prescribing doctor so that blood tests can be carried out and any possible adverse effects discussed.
Are there any contraindications to the use of AndroFeme?
Doctors will check if you have or have had any of the following:
- Breast cancer
- The kidney disease known as nephrotic syndrome
- A thromboembolism (blockage of a blood vessel by a blood clot)
- High calcium levels in the blood.
Doctors do not prescribe AndroFeme to women who are still menstruating, are pregnant or are breastfeeding.
