Testosterone can be prescribed in pill, patches, creams, suppositories and lozenges (also called troches) in compounded or synthetic forms. Non-pill preparations that bypass the liver may be the best place to start. A six-week trial is generally recommended. Here are two options:
- Under-the-tongue troches. "Testosterone lozenges can be used intermittently as as a kind of jump-start for libido," says Dr. Youcha. "You could, for example, take a lozenge after dinner in preparation for sex that night," suggests Dr. Youcha. A recommended starting dose is 0.2 milligrams (for methyltestosterone) or 0.5 milligrams for compounded testosterone.
- Topical cream. An array of creams and gels that can be rubbed directly on the vulva can be prescribed. "Methyltestosterone does not get converted to estrogen so these preparations may be theoretically safer," according to Dr. Youcha. Preparations range from 1 percent to 2 percent. If you have the right dosage for your body, the effects of the creams can kick in as early as a half-hour later.
Testosterone replacement need not be long-term. "Once the sex behavior has shifted, you can stop testosterone and see how sex goes without hormones," Dr.Youcha says.
Work on it as a couple. When a woman turns off sexually, her mate may feel undesired. He may withdraw, causing the woman to shut down further. "Couples need to find ways to reconnect both verbally and non-verbally outside the bedroom," says Karen Brash McGreer, marital and sex therapist in Cherry Hill, N.J. She counsels couples to do things that help to build intimacy:
- Take a walk after dinner or have coffee on Saturday morning (no kids).
- Tell your partner what you need to feel aroused — that may be words, cuddling or other signs of affection.
- Talk about the redistribution of the workload. A skilled therapist can help you resolve deeper conflicts and to "bring it up, talk it out, let it go." You can then advance to techniques that focus on stimulating sensations without actually having sex. For example, deepening eye contact and breathing together helps build trust.
- Take steps to resexualize yourself. You are responsible for your own pleasure, "but you have to work at it," says Kellogg-Spadt. For 20 minutes, three times a week, get your brain off the cub scouts, soccer club and grocery lists and do some fantasy work. For many women, reading erotica is an effective trigger. Treat yourself to sensual pleasures — dance lessons, a pedicure or even a massage. Lastly, engage in exercise such as yoga that involves squats, lunges and lifting. This helps blood flow in the pelvis and clitoris. Yoga also helps open your body to sensations and can boost your body image.