I'm a 28-year-old woman who has never had a desire for sex. I just recently found out that my testosterone level is virtually undetectable by lab values. I tried to ask my physician if I should try testosterone pills or cream, but never got an answer. Would the pills or cream help me since I'm not menopausal? If so, which is better and what side effects should I watch out for?

Tami

Most premenopausal women have adequate testosterone levels, but some, like you, have very low levels. These women may indeed benefit from supplemental testosterone. Most of the testosterone pills available are too strong for women. Compounding pharmacies can make oral testosterone in doses more suitable to most women. Compounding pharmacies make testosterone ointments as well. The ointments are rubbed into the labia according to a schedule prescribed by your doctor -- for example, you might be instructed to use it every other day, or 30 minutes before intercourse. Follow-up testosterone levels can be drawn to see if you are receiving and assimilating an appropriate amount of testosterone.

Side effects of testosterone may include oily skin, acne, increased facial and body hair growth, deepening of the voice, growth of the clitoris, depression, and increased anger or aggression. The most common side effects are oily skin and acne; more serious side effects like facial hair growth are uncommon with the testosterone creams that are most often prescribed. Where I practice, in the arid climate of the mountains and high desert on the California/Nevada border, most of my patients welcome oily skin, although in more humid areas this could be more of a problem.

If you have explored all other avenues, including therapy, to treat your low sex drive, and because your testosterone level is low, use of a cream may be worth a try. Not all women will respond, but those who do can achieve a significant improvement in sexual desire. Good communication with your doctor is essential in maximizing effectiveness and minimizing side effects.