In 1997, at age 47, former model and talk show host Cristina Ferrare began exhibiting signs of menopause. When she told her doctor, Los Angeles gynecologist Judith Reichman, about her mood swings, hot flashes and loss of libido, Reichman prescribed an ointment containing the hormone testosterone. “For women like Cristina,” says Reichman, 53, “who come in and say, I used to really enjoy sex and now I couldn’t care less,’ it works wonders.”
Although Reichman has been prescribing testosterone (it also comes in pill and lozenge form) for a decade, the medical establishment is just beginning to address the issue of using the hormone to treat women who have low libido. “There is still resistance from male doctors,” says Boston psychiatrist Susan Rako, author of The Hormone of Desire: The Truth About Sexuality, Menopause and Testosterone. “Some people can’t shake the idea that somehow testosterone belongs to men, even people who know better.” Reichman too attributes the lag to sexism. “A man who can’t get an erection because of low testosterone levels is treated like-an endocrinologic catastrophe,” she writes in her book I’m Not in the Mood: What Every Woman Should Know About Improving Her Libido. “A woman with a testosterone deficiency that leads to sexual problems [one study found that 40 to 60 percent of menopausal women in the U.S. lose interest in sex] falls into the category of ‘Oh, well, use a lubricant and grin and bear it.’ ”
The Manhattan-born daughter of Lillian, 74, a pianist and music teacher, and violinist-turned-theoretical physicist Israel Senitzky, 79, Reichman chose medicine after the New York City Ballet’s cofounder, the late George Balanchine, told her that her torso was too long and her arches too developed for her to succeed as a dancer. After graduating from Manhattan’s Barnard College in 1966, she moved to Israel and later that year met and married an Israeli paratrooper. (They have two daughters, Ronit, now 29, a Tel Aviv TV producer, and Anat, 19, a student at Mills College in Oakland.) A 1971 graduate of the Sackler School of Medicine at Tel Aviv University, Reichman did her residency at the University of Chicago before setting up practice at Cedars-Sinai Medical Center in Los Angeles in 1980, the same year she and her husband divorced. In 1987 she married Gil Gates, now 64, producer of the Academy Awards telecasts, with whom she shares a sprawling Westwood apartment.
Of the five to eight women a day for whom she prescribes testosterone, Reichman says, “80 percent are very happy with it.” Ferrare included. “I haven’t had any side effects,” she says. “Well, I do have major orgasms,” she adds, laughing, “the greatest side effect!” Reichman spoke with correspondent Vicki Sheff-Cahan about testosterone and its effect on a woman’s libido.
Why did you first prescribe testosterone ointment to your patients?
I started using it to treat a condition called lichen sclerosus et atrophicus, which causes chronic vaginal itching but isn’t a yeast infection. I began getting calls from patients saying, “I’m really horny” and “I feel things I haven’t felt in 20 years.” It gave me the idea of using the ointment to aid the libido.
Who can benefit?
It’s for the woman who has had a change, who notices that nothing arouses her, whose lower pelvic sense of Wow! is no longer there.
Aren’t these symptoms usually treated with estrogen?
Yes. But I started hearing complaints from menopausal women whose problems—including not sleeping well and hot flashes—weren’t being helped with estrogen alone. More and more data showed that if estrogen alone failed, adding testosterone could help.
Why isn’t it prescribed more often?
When a woman shows up complaining about reduced libido, her testosterone levels are rarely checked. Even if they are, many doctors don’t do anything about it. They tell women to go home and watch erotic movies—as if we are somehow at fault and can fix it. Erotic movies or books will do very little if their testosterone levels are on the floor.
Are there women who shouldn’t use testosterone?
I won’t give it to women who could become pregnant while using it or those whose testosterone levels are fine. Or women on antidepressants that totally knock put the libido. Nor will testosterone help those whose lack of libido is from horrendous psychological, body image or sexual-abuse issues. I refer them to a sex therapist or a psychologist.
What are the long-term effects of using testosterone ointment?
There are not a lot of long-term data because this is not a paramount concern of the medical establishment. I can promise a better quality of life, but I can’t say that if you take this for the next 30 years what protective or adverse effects it will have.
Why not give women Viagra?
Viagra dilates blood vessels and allows them to swell. It makes women feel fuller and feel a heat down there, which helps with arousal and lubrication. But it does not work on the libido. In men, Viagra probably doesn’t directly affect libido either. But it gives men erections. If they can’t achieve erections, this is performance failure, which affects their psyches and ultimately their libidos.
What is your advice to women who want to improve their libido?
See a doctor. It isn’t something you have to accept. I’ve had women say, “You saved my marriage.”