Men seem to have a drive to procreate that generally exceeds that of their female partners during most phases of life. With that in mind, one may wonder if a jolt of testosterone, the hormone quintessentially considered male, would improve sexual satisfaction for women.

This was the premise of a research trial published recently in the Annals of Internal Medicine. The researchers divided 261 pre-menopausal women with known low testosterone levels into several smaller groups: some of the women were treated with low, medium, or high doses of a testosterone spray and others with a placebo (ineffective) spray. The study found that women using a moderate dose of the testosterone spray had greater sexual satisfaction scores than the placebo group or those who received lower and higher doses of testosterone. From this, the researchers concluded that the moderate dose of testosterone improved sexual satisfaction in this group of women.

But not so fast! While the data may have supported that conclusion, I don't think it is supported by logic. These results from one small study certainly won't lead me to change my practice when women complain of low libido. If the testosterone were effective, you would have expected a dose-response effect such that the low-dose improved sexual satisfaction a bit, the intermediate dose a bit more, and the high dose a lot.

Further, there are many innate challenges in testing a medication for such a subjective condition. The women in the study completed surveys to build the database of sexual satisfaction scores, and I expect that the mere fact of being asked about sex may have made them more inclined to have sex. I certainly can't prove my assumptions, though.

So how do I treat women who complain of losing interest in sex? I approach it differently than I do for men - in them, I start with a hormone evaluation, especially if they have erectile dysfunction (inability to get an erection). Even for those men, I usually can't point to a clear cause like a low testosterone level. More often their issues are related to depression or excessive stress.

In most of my women patients, the most common cause of low libido is stress, so that's where I start. Being too busy, financially strapped, overburdened at work, or underappreciated at home can lead to high stress levels which generally translate into a repressed interest in sex. Sometimes life may be going swimmingly but there is an underlying anxiety or depression that will squash any interest in sex. While stress is the bane of many and is challenging to treat, there are medication and counseling options for true anxiety or depression.

I next review the onset of this change of interest. Has it developed gradually, particularly since menopause? Was it after starting a new medication? Many blood pressure and depression medicines can lower libido. Oral contraceptive pills can also affect libido, but that is easily fixed by switching to an alternative pill with a different progesterone or estrogen dose.

Next, I inquire about specific worries. Are you worried about getting pregnant? We can start a contraceptive. Do you fear pain from intercourse? (This is a common fear post-partum.) Consider using a lubricant like K-Y jelly or seeing a urogynecologist, a specialist who can evaluate any possible physical causes of the pain. Do you worry about getting a urinary tract infection (UTI)? Prevent it by drinking plenty of fluids, urinating before and after intercourse, and a daily cranberry supplement.

Lastly, I ask about the state of the relationship. Have you talked about the issue with your partner? An open discussion about your wishes and expectations of intimacy, including your sexual satisfaction, can go a long way toward improving your libido without the bother of an only-possibly effective testosterone spray.