After years of a marriage that had little sex in it, Greg Carter had largely accepted that his wife no longer had any interest. The last thing he expected was that right around the time that they both were nearing 50, his wife would have a complete change of heart. “She was pouncing on me,” he said.
His wife had recently started taking testosterone to manage her menopausal symptoms — at a dose so high that it brought her testosterone levels higher than is typical even for women in their 20s. The difference in her desire was almost immediate. “I had the experience of feeling like a teenage boy,” she told me. The shift vastly improved Greg’s own happiness, so much so that he sometimes felt pangs of regret about the years they spent together without a sex life. “I realized, later in life, all that we had missed out on,” he says.
Earlier this year, I published an article on how women are increasingly — with widely varying results — seeking out testosterone to help them with energy or their sex lives. Some women who take testosterone at relatively low doses approved by major medical societies feel little change in their bodies, while others see an increase in their desire. Women who take high doses — doses that exceed levels approved by major medical societies — often report sharp upticks in their interest in sex.
Franny’s doctor prescribed her testosterone (along with estrogen and progesterone) in what’s known as a pellet, a small medical product the size of a grain of rice that is inserted beneath the skin. Often those pellets, which release hormones over the course of several months, provide doses of testosterone that bring their levels much higher than those that women would have naturally — which was true in Franny’s case.
“I feel like I want it sometimes more than my husband,” Franny told me when I was reporting my original article. There was a hint of nervousness in her tone of voice — that dynamic was a shift from their norm and one that made me realize it wasn’t just Franny’s life that had changed, but also Greg’s. And that made me wonder what it would be like to be the partner of someone who was undergoing such a radical shift.
Your Questions About Menopause, Answered
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What are perimenopause and menopause? Perimenopause is the final years of a woman’s reproductive years that leads up to menopause, the end of a woman’s menstrual cycle. Menopause begins one year after a woman’s final menstrual period.
What are the symptoms of menopause? The symptoms of menopause can begin during perimenopause and continue for years. Among the most common are hot flashes, depression, genital and urinary symptoms, brain fog and other neurological symptoms, and skin and hair issues. Here’s a head-to-toe guide to the midlife transition.
How can I find some relief from these symptoms? A low-dose birth control pill can control bleeding issues and ease night sweats during perimenopause. Avoiding alcohol and caffeine can reduce hot flashes, while cognitive behavioral therapy and meditation can make them more tolerable. Menopausal hormone therapy and the selective serotonin reuptake inhibitor paroxetine can also ease some symptoms.
What is Veozah? Veozah is the firstnonhormonal medication to treat hot flashes in menopausal women; it was recently approved by the F.D.A. The drug targets a neuron in the brain that becomes unbalanced as estrogen levels fall. It might be particularly helpful for women over 60 because, at that age, starting hormonal treatments can be considered risky.
How long does perimenopause last? Perimenopause usually begins in a woman’s 40s and can last for four to eight years. The average age of menopause is 51, but for some it starts a few years before or later. The symptoms can last for a decade or more, and at least one symptom — vaginal dryness — may never get better.
What can I do about vaginal dryness? There are several things to try to help mitigate the discomfort: lubricants, to apply just before sexual intercourse; moisturizers, used about three times a week; and/or estrogen, which can plump the vaginal wall lining. Unfortunately, most women will not get 100% relief from these treatments.
What is primary ovarian insufficiency? The condition refers to when their ovaries stop functioning before the age of 40; it can affect women in their teens and 20s. In some cases the ovaries may intermittently “wake up” and ovulate, meaning that some women with primary ovarian insufficiency may still get pregnant.
Fact, or fiction? We asked gynecologists, endocrinologists, urologists and other experts about the biggest menopause misconceptions they had encountered. Here’s what they want patients to know.
Greg, now 54, told me that their marriage was always, overall, a happy one. They supported each other over the years as Franny wrote poetry and taught writing while Greg built a career in fund-raising. He had headed into marriage assuming that sex would always be part of their lives together; instead, by the time they were in their 40s, their sex life had almost collapsed altogether. “It was emotionally frustrating,” he says. “At some point, you just come to accept it.”
Eventually, he hesitated to approach his wife sexually. For many years in her 40s, she says, she did not even want to be touched. Both of them were pained by the absence of sex; it hung between them, with Franny feeling guilt along with some resentment about that guilt, and Greg feeling disappointed and resigned.
And then the introduction of testosterone turned the tables in their relationship. Franny started thinking about sex all the time, daydreaming about it, initiating it; she was less inhibited during sex, they both noticed. She was also interested in having sex often enough that Greg decided he needed to find an alternative to a medication he was taking whose side effects included a lowered libido. He sometimes felt bad that he couldn’t meet her where she was. He worried she sometimes felt hurt, and he felt “horrible,” he says. He ended up changing medications; now, he says, they have sex about twice a week. They both still consider it a positive change that if one of them would like to be having even more sex, it’s Franny.
There isn’t a lot of research on the effects of taking high doses of testosterone. Low doses — doses that restore women to the levels they typically had in their late 30s or early 40s — have been sufficiently studied in postmenopausal women that major medical societies recommend it as an option for women in that age category who are distressed by low libido. At those doses they don’t tend to have side effects.
But much less is known about the long-term effects of high doses. Doctors do know that when women have testosterone levels that surpass what they’d ordinarily experience, they might have more facial hair, thinning or loss of hair, acne, a deepening of the voice and in some cases, an enlargement of the clitoris. One woman told me that she lost nearly half of her hair. Another reported that even after she stopped taking testosterone, she had coarser, darker hair on her face that she struggled to manage with tweezing and waxing. I also heard from women whose high levels of testosterone set them aflame primarily with rage.
Many doctors point out that taking those high doses hasn’t been studied in long-term randomized controlled trials. Sharon Parish, a specialist in women’s sexual health who is a professor of medicine in clinical psychiatry at Weill Cornell Medicine, cautions that there is reason, based on other research, to be concerned about the understudied and therefore unknown long-term cardiovascular and hormone-related cancer risks in those women who take high-dose testosterone.
Greg and Franny have talked about the unknown health risks of taking testosterone in high doses. “I know I probably should be concerned, Franny told me, “and there is a part of me that is concerned. But I just know there is a big quality-of-life difference.”
She counts herself as lucky: She has noticed only slightly more facial hair, a problem she has found she can manage with a good pair of tweezers. But whatever physical changes she is monitoring carefully, Greg hasn’t noticed.
He is inclined to leave decisions about Franny’s own health to her. “I know there are some unknowns,” Greg says. “But it’s her life, and I trust her judgment.”
What has surprised him the most is how much about their relationship has changed along with their sex life. “Instead of just staying in on the weekends, doing yard work, watching Netflix, we’ll go out, get a drink, meet friends at a restaurant. We enjoy each other more. There’s a lot more playfulness to our lives.” Some of that, he knows, is the increased confidence that comes from being happy in one’s sex life; but he also knows the two of them feel much closer. They have a spark between them — shared in jokes, racy allusions.
“I’m a Midwestern guy, like in that old joke — the Midwestern guy who loved his wife so much he almost told her,” he says. Now they talk more freely about sex, but also about other aspects of their emotional lives that they previously left unexplored.
Franny knows the marriage is much stronger than it was. “I fear my husband was really walking on eggshells with me before,” she says, “and I hate that for anyone. We’re a lot closer. We have a lot more fun.”
The past few months have been challenging, as they have moved Franny’s aging mother from her longtime home to live closer to them — an emotional and logistical trial common to people in middle age. “But we were having an active sex life during this phase too,” Greg says. “And it’s been such a great outlet.”
“It’s made life more exciting,” Greg says. “The thought that you come home and you think, Hey, we might have sex tonight.”
The post What It’s Like When Your Wife Goes on Testosterone appeared first on New York Times.
