Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More

Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More. There is no doubt that testosterone, an androgen, or male hormone, plays a part in sexual arousal and appetite. Though this hormone does have an impact in both men and women, the fact is that sexual appetites are highly mediated by mood, values, beliefs, experience, relationships, physical complications, medications, and a host of other conditions. Teasing out how much of a role testosterone really has can be difficult. But we’re up to the challenge and in this myth we look at the research for both men and women.

Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More
Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More

Testosterone in Men
Testosterone is a sex hormone that is produced by both the testes in men and the ovaries in women as well as the adrenal glands in both men and women. It is responsible for secondary sex characteristics in men such as facial hair, body hair, and deep voice. Testosterone has an activating effect on sexual desire for both men and women (Kelly, 2011).

For men, androgens are a core part of the erectile system. Studies of erectile dysfunction have found that low levels of free testosterone correlates with impaired ability of the cavernous endothelia and corporeal smooth muscle cells to deliver enough blood for the penis to become rigid (Aversa et al., 2000). Further, several studies have shown that low testosterone levels will correlate with lower sexual desire (Aversa et al., 2000). It is not true, however, that having high testosterone levels will always correlate with more sexual activity or better erections (Anderson et al., 1992; Bagatell et al., 1994).

Erection and arousal issues may have an organic origin but unless lower than normal levels of free testosterone are found, or there is some injury to the genitals, the primary causes of lack of arousal or erection are thought to be mostly due to psychological issues with sex, performance fears, relationship woes, or lack of attraction (Aversa et al., 2000; Buvat and Lemaire, 1997).

The part that testosterone plays in sexual drive is actually a controversial subject among researchers. A number of studies have indicated that total testosterone was related to erectile ability but not sex drive, except among aging men where less bioavailable testosterone was present (Gades et al., 2008). Another study also found correlations to erection but not sex drive (Ahn et al., 2002). The long-running Massachusetts Male Aging study found no correlation with either total or bioavailable testosterone and erectile functioning (Gades et al., 2008).

Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More

These findings, however, were somewhat modified by a meta-analysis of 17 trials by Boloña et al; they felt that testosterone had a direct effect on erections and a modest effective on sex drive (Boloñaet al., 2007). In addition, a study of Korean sex offenders who were chemically castrated using drugs to inhibit testosterone came to the conclusion that testosterone was the mediating agent for sexual arousal. However, the authors did say they could not be positive about their results because of a small sample, the fact that there was no placebo/control group, and the possibility that the offenders were not being honest in their selfreports (Koo et al., 2013).

Even more controversial than the role low testosterone level has in sex drive is the question of what to do about it. If a low testosterone level is truly present, many doctors recommend testosterone therapy which is used to help increase sexual interest and create better erectile function (Bancroft and Wu, 1983; Kwan et al., 1983; Cunningham et al., 1990; Rakic et al., 1997; Aversa et al., 2000).

In a recent article, Ronald Swerdloff, chief of the division of endocrinology and metabolism at the UCLA School of Medicine, stated “Men who have repeatedly tested low for testosterone concentrations in their blood and who also have symptoms consistent with testosterone deficiency are reasonable candidates for treatment” (Nutrition in Action, 2014). But testing is difficult. Swerdloff goes on to say, “Some men may have a low level on one day, but a week or a month later, they may be back to a completely normal level”(Nutrition in Action, 2014).

There are some interesting and subtle factors of how the mind influences the body that suggest that testosterone deficiencies themselves as well as reduced blood flow to the penis might actually be due to stress factors or, often, relationship factors. Difficulty or hostility at work, in the family, or in a relationship, for example, may cause decreased testosterone levels. To quote one group of investigators, “Present data show that, in subjects consulting for sexual dysfunction, deterioration of the couple’s relationship may be associated with impairment in sexual activity, which, in turn, can lead to a mild hypogonadism”(Corona et al., 2009).

Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More

In other words, it’s not just sex drive and erections that are influenced by psychological factors, testosterone levels themselves are highly influenced by emotions (Aversa et al., 2000; Corona et al., 2009).

Researchers are also concerned about the long-term effects of adding testosterone. Some believe that there is not enough information available yet to know whether potentially dangerous side effects come with long-term use of replacement therapy (Gades et al., 2008–2013; McKinlay, 2006).

Testosterone in Women
If you think the action of testosterone is a controversial topic concerning men, it is nothing compared to the friction in the medical and behavioral science communities over the function of testosterone in women — and the dangers that hormone drug therapy may present to women. At issue are various kinds of testosterone treatments: oral testosterone, transdermal testosterone, testosterone patches, sublingual testosterone, intramuscular, subcutaneous, pellets, gels, and creams (Hubayter and Simon, 2008).

Here, we start with rats (sorry ladies). Researchers looking for a medical way to reduce or change what they consider to be low sexual desire in women (or what women and/or their partners consider a lack of ability to want or enjoy sex) first started to see if they could arouse female rats. One study used looked at vardenafil, a PDE5 inhibitor similar to that found in Viagra, in combination to see if they could produce some horny rodents.

Neither testosterone injected under the skin nor an oral version of vardenafil worked on their own, but when they put the two together female rats became more receptive to male mounting behavior and also sought out the males for sexual activity (Snoeren et al., 2011).

Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More

Other studies have carried out similar tests on human females. Van der Made et al. (2009) applied the combination of testosterone and vardenafil to women patients who said they had extremely little or no sexual desire and concluded that the combination enhanced desire and was demonstrated by more sexual arousal when they watched erotic images.

A few double-blind studies on women with deficient hormonal levels found that being treated with estrogen produced some changes in sexual desire (Mulhall et al., 2004; Bain et al., 2007). Other approaches included using testosterone with estrogens in women who no longer had functioning ovaries. This was deemed to improve sexual interest (Snoeren et al., 2011).

Stephanie Page, a researcher at the University of Washington, has written that “some good trials show a small benefit for sexual function in women who have undergone surgical menopause or who are naturally menopausal”.

A batch of studies, some of them with very small samples, have looked at women’s natural peaks of testosterone around ovulation and found correlation with sexual gratification when intercourse or other sexual activity occurs at that time. One study of 11 couples found that high baseline testosterone, but not daily testosterone, was related to women’s positive evaluation of their sexual experience (Persky et al., 1978).

While all researchers admit that there is not enough research on the use of testosterone alone as a mediator of female sexual interest, there is a lot of “offlabel” use. “Off label” use means the drug has been approved by the Food and Drug Administration (FDA), which has demanding standards, but not for the use it is currently being applied to. So, when synthetic testosterone which was approved for erectile problems in men is used for sexual arousal in women without being tested for efficacy and safety, that use is referred to as “off label.”

Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More

Nonetheless, some doctors feel the use of testosterone in various hormonal combinations for women who are upset about the loss of sexual interest is appropriate. For example, Estratest, a common hormonal combination, is FDA approved to help women suffering from extreme postmenopausal discomforts (sleeplessness, hot flashes, headaches, and other problems) but is being used “off label” as a way to increase sexual interest in women.

Research suggests that the combination of estrogen and testosterone increases blood flow to the vaginal area, clitoral sensitivity, and rates of orgasm. As a result it increases sexual desire and behavior. It can also prevent vaginal atrophy among older women or women who have had their ovaries removed (Lobo et al., 2003; Hubayter and Simon, 2008).

Advocates of testosterone therapy admit certain possible negative side effects such as increased skin oiliness, acne, deepened voice timber, changes in personality such as increased hostility, weight gain, and hair loss. Other side effects include elevated liver function, lower HDL levels (high density lipoprotein, the good cholesterol), and even carcinoma (a type of cancer) (Hoeger and Guzick, 1999; Redmond, 1999; Snoeren et al., 2011).

A particularly troubling study published in the New England Journal of Medicine found that when 209 men with low testosterone levels were involved in a study that gave some men testosterone and others a placebo, the men who received additional testosterone were five times more likely to have a heart attack or other heart problems. This was so worrisome that the researchers cancelled the research (Nutrition in Action, 2014).

Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More
Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More
Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More

Still, there are clearly clinicians who feel that the chances of these side effects are slight and the benefits may be worth it. The presence of these side effects is not a minor issue to a large group of critics who are fighting the legitimization of testosterone therapy for women.

They believe women’s bodies have been used as experimental laboratories for a lot of drugs (for example, high dose contraceptive pills). Perhaps the angriest commentary on testosterone therapies comes from a group of feminist researchers and clinicians who feel that the whole concept of low sexual desire for women has been invented.

Testosterone Is the Main Predictor of Sex Drive in Men and You Can Always Add More

Chief among these critics is psychologist Lenore Tiefer (2001), who, with a number of other therapists, clinical professionals, and researchers, feels that the definition of “low” desire is highly biased because it is based on male standards and male needs. They argue that an arbitrary standard of sexual desire has been created and that the attenuation of desire in women may be “natural” and appropriate and should not be problematized.

Instead of telling women that a certain level of desire is “normal” and anything different from that is a problem that needs to be fixed, they suggest that we normalize the continuum of desire that clearly exists among women, especially postmenopausal women.

So Why All the Fuss About Testosterone?
Testosterone has received much attention in many ways because it seems like a potentially quick fix. Unfortunately, the role of testosterone in sexual arousal and behavior is anything but straightforward and while looking for medical answers to a lack of sexual interest is reasonable and may have worthy outcomes, the fact is that at present we do not have a simple explanation for lower sexual desire or difficulties with arousal. While we know testosterone has a role, we can’t pinpoint it precisely, which means we can’t simply say add some more and all will be fine.

Most sex therapists believe that except for severe hormonal deficiencies (which may need a medical answer), the answer for most sexual issues will be found by looking more closely at psychological, emotional, and relationship issues.

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