Archive for February 5th, 2011

Sex is between the ears as well as between the legs. –  H.L. Newbold

There was a big discussion recently in the comments following my July 24th column about male sexuality vs. female; though I insisted that it’s a difference of kind rooted in brain architecture, regular reader Asehpe wondered whether it might not simply be a difference of degree deriving from men’s much higher testosterone levels.  I’m sure all my readers realize that men’s testosterone levels are much higher than women’s, but some of you may not realize just how much higher: the normal male level ranges from 300-600 nanograms/milliliter of blood (ng/mL) while the normal female level is only 10-30 ng/mL.  In other words, the lowest normal male level is still ten times the highest normal female level.  And since degree of sex drive is roughly related to testosterone levels in both sexes, it should come as no surprise that men tend to be such horny beasts in comparison with women.  Because the ovaries produce most female testosterone (a small amount comes from the adrenal gland), women’s levels often drop dramatically after menopause and their sex drives often drop with the level. Some such women get positive results from a testosterone patch, but many others don’t, and some women don’t experience any noticeable dip in sex drive after menopause.  And that brings us to this article by Dr. Ricki Pollycove which was published a week ago Wednesday (January 26th) on Huffington Post; she talks about the complexities of female sexuality and why testosterone isn’t always the answer, and in light of the previous discussion I thought my readers might be interested.  IMHO, it tends to support my position that the male/female sex drive difference is one of brain-based kind rather than testosterone-based degree, but read the article and decide for yourself; here are a few highlights.

…There are many complexities to the science regarding testosterone and its androgen cousins…The actual science of measuring testosterone (T) in women is where a lot of our problems begin.  The levels found naturally in women are less than a tenth of those produced by 30-something aged men.  With such a small female range of “normal,” the individual difference between our cyclic high point (right around ovulation in menstruating women not using hormonal contraception) and the pre-menstrual period low is relatively small.  And on top of this, the T levels between different women vary considerably.  And to make it an even tougher puzzle to solve, a particular T level, as measured by the most accurate blood testing methods, does not correlate with better or worse sexual satisfaction when different women are compared to each other.  So even if you get the best “gold standard” testosterone blood test and “know your numbers” it may not correlate with your personal experience one way or another…

In other words, some women with comparatively low testosterone levels have higher sex drive and better sexual satisfaction than other women with higher levels; there’s no direct correlation between different women.  After my hysterectomy my endocrinologist monitored my hormone levels while we were trying to determine the best hormone replacement therapy (HRT) for me; upon discovering that my post-hysterectomy testosterone levels varied between about 2-5 ng/mL he asked if I had experienced any drop in sex drive and appeared surprised when I told him my desire had actually increased!

…Women who seek improved sexual function…are likely to get a blood test, often to find out that their levels of testosterone are considered “normal”…Depending on the T hormone study (often conducted by departments of psychiatry, where sexuality research is most at home in our culture), the strongest statement that stands up to rigorous science is that among women who complain of lackluster sexual functioning, added T can be of statistically significant benefit IF their blood levels…are below the middle third of the normal range.

What this means in English is that if a woman who complains of low sex drive has a low (10-16 ng/mL) testosterone level, giving her extra testosterone often (but not always) increases that drive, but if her levels are about 17 ng/mL or higher it doesn’t usually have any significant effect.

Part of the problem is how doctors research and measure sexual experience in women…Studies in women are more difficult as compared to men.  Male measures of orgasm/ejaculation are clear cut end points of sexual satisfaction whereas women have a less defined description of what constitutes satisfying sex with a partner.  With the mix of issues surrounding T measurement, absolute levels of T not correlating well with an individual woman’s sexual function and the placebo effect being very powerful with regard to sexual performance (30 to 40 percent improvement with the dummy pills or creams), it’s no wonder we are still stuck with a huge difference of opinion between professionals who take care of women’s hormonal balance…

It’s easy to tell if a man is aroused, and a healthy aroused man should be able to achieve orgasm, but it ain’t necessarily so with women.  The article states that “the ability to achieve orgasm is not highly correlated with T levels” in women, yet women who only think they’re getting a “horniness booster” still show 30% improvement even though it’s all in their minds!

…It may indeed be valuable to learn if your T level is in the lowest third of women, as this group is significantly improved with some added T support.  But the chances are that your blood levels are in the middle or upper third group of women.  You can try DHEA (over the counter) as T support if your blood T level is mid-range or at the bottom third. You may risk getting more pimples, especially on chin, nose, forehead and areas around the mouth with rising T levels, even when in normal ranges.  And too much T is NOT a good thing!  Beyond skin and hair changes (like zits and balding at the temples) there is a higher risk for a variety of diseases, like cardiovascular disease risk, stroke and liver tumors with overdoing it with T…

…The good news is that behavior modification can be a big help for many women.  Don’t take the laptop to bed.  Don’t watch TV in bed, dozing off next to your partner once again without so much as a good cuddle…Are you actually allowing arousal/foreplay activities before you hit the annoyance level?  So go ahead, take a combined approach of a medical and hormone evaluation plus enjoy the full spectrum of behavior modification activities…whatever suggests romance to you.  If we are to enjoy living with our partner beyond acting like parallel parked cars in a garage, it requires intentional efforts long term.

Here’s the meat; though some women’s sexual problems are indeed hormonally based and can benefit from replacement therapy if the levels are unusually low, most women’s sexual problems derive not from what’s going on in their bodies but from what’s going on in their heads.  Dr. Pollycove concludes the article with the statement “don’t just focus on testosterone as it may be less of a factor than we once thought,” and I heartily agree with her.  She and I are both experts in different aspects of human sexuality, but our experiences have in this case led us to the same conclusion via two different routes.  My low testosterone levels never affected my sex drive because I’ve always been open to sex; IMHO what’s going on in a woman’s bloodstream pales into insignificance beside what’s going on between her ears.

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