Topical estrogen or testosterone for libido?
Meet the Experts
Leslie R. Schover, Ph.D. is a renowned psychologist with a special interest in helping people resolve or manage their sexual problems, especially those problems connected with a chronic illness such as cancer.
Debra Thaler-DeMers, R.N., O.C.N., P.H.N. is a hematology-oncology nurse at the Peterson Cancer Center of the Stanford Hospital in Stanford, California, and President of Cancer ACCESS, an advocacy and counseling organization for people affected by cancer.
Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.
Question from Jely: After chemo and now tamoxifen, I have zero libido. What do you think about topical estrogen or testosterone to address this? (My breast cancer was slightly ER+ and PR+)
- Answers —Leslie Schover, Ph.D.: Estrogen does not have any impact on a woman's desire for sex. Estrogen works directly on the vagina to help it produce moisture and stay stretchy. The hormone that affects women's desire is testosterone, which acts in the brain to promote interest in sex. When a woman has had chemotherapy and her ovaries are damaged, she does usually have less circulating testosterone in her blood stream. However, a woman only needs a very small amount of testosterone or related hormones to feel desire for sex.
The adrenal glands, which sit on top of each kidney, produce about half of a woman's circulating testosterone-type hormone. For many women, this remains enough after menopause to keep a normal desire for sex. Unfortunately, there are no safety studies showing that it is okay for breast cancer survivors to use topical testosterone. The amount of hormone in these creams varies a lot, and it can be absorbed into the blood stream through the thin skin of the vulva. Once in the blood stream, testosterone can act directly on any remaining breast cancer cells. It also can be converted to estrogen by fat cells in the body. There are studies showing that high testosterone is a risk factor for women to get breast cancer and so this remains a concern. - Marisa Weiss, M.D., president and founder: If you've lost your sexual desire or the ability to enjoy sex, it may be due to thinning of the vaginal walls that may be improved by lubricant, but not made sufficiently better. You might ask your doctor to consider the possibility of using an estrogen preparation in your vagina to help restore the moisture and resilience of the vaginal walls. I know that many doctors feel comfortable using the E-string, a small ring containing estrogen that is put up inside the vagina and replaced every few months. At Memorial Sloan Kettering, for example, many of the oncologists do feel comfortable using it, even in women who had a cancer that had hormone receptors present. This requires a careful discussion with your own doctor, of course. There are other preparations as well including Premarin estrogen cream. Some gynecologists may recommend using 1/2 applicator full a few times a week. Again, talk to your own doctors about these possibilities.
- Leslie Schover, Ph.D.: The advantage of the E-string is that the estrogen is released very slowly and in very small amounts. After the first week, the lining of the vagina gets thicker from the estrogen and after that very little hormone gets into the bloodstream where it could meet up with a cancer cell.
- Debra Thaler-DeMers, R.N., O.C.N., P.H.N.: Another advantage of the E-string or Premarin is that these are items that may be covered by your insurance.
- Marisa Weiss, M.D., president and founder: If cost is an issue for you, there are cheaper lubricants. Some women manage with plain yogurt. And I have some patients who like to use olive oil. An oil-based lubricant should not be used with condoms, however.
On Wednesday, February 20, 2002, our Ask-the-Expert Online Conference was called Intimacy, Sex and Your Love Life. Leslie R. Schover, Ph.D., Debra Thaler-DeMers, R.N., O.C.N., P.H.N., and Marisa Weiss, M.D. answered your questions about how to improve your sex life during and after breast cancer treatment.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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