Which symptoms indicate that hormone changes are causing a low libido?
Minkin: Vaginal dryness or pain during intercourse. Before I do any fancy workups on a patient who’s experiencing these problems, I prescribe a vaginal estrogen cream, which you apply directly to the labia. That solves it for many women. Just about anyone — even breast cancer patients — can use estrogen cream. Now, let’s say we fix the dryness or pain, but the woman still has no interest and she knows it isn’t a lifestyle or a relationship issue. We’ll test her hormone levels, and then we might try systemic estrogen in pill form or testosterone. Unfortunately, in the United States we don’t have an FDA-approved testosterone for women, so I’ll do an off-label prescription of a very small dose of the type approved for men or try a testosterone cream that can be applied to the thigh or labia. This increases blood flow to the genitals, aiding arousal. There are a few adverse side effects with testosterone — like increased facial hair and acne — but with a small dose, it’s not a big deal
