I saw recently where you wrote about testosterone available to improve the libidos of menopausal women. My question is: Is this available for a 35-year-old premenopausal woman who lacks interest in her husband? This has been going on for two years. Are my hormone levels an issue? I can't convince my doctor that I need some type of diagnostic test. What next?

--Lynn

Sexual desire is a complex interplay of the physical and the emotional. While it is true that an abnormally low testosterone level can decrease sexual desire, the most important sexual organ is the one between your ears -- your brain. In evaluating decreased libido, we must consider not only physical factors, but also the relationship between you and your husband; your daily life and associated stressors; and recent changes like a new baby, a job or a move. If you have pain with sex, then naturally your desire for sex will be low. If you are a new mom, up all night with a baby, then it's understandable that the last thing on your mind is sex -- five minutes to yourself would be a much higher priority. If you are angry with your husband, or worried about finances, or unhappy with your body -- or his -- these things affect sex drive. An underactive thyroid or depression can interfere with desire; so can medications like birth control pills, steroids, narcotics, antidepressants and sedatives, as well as drugs like alcohol and cocaine and speed. Past sexual assault or rape is sometimes a factor.

You need to see a gynecologist who is very experienced in dealing with issues of sexuality. Medical and physical problems need to be ruled out. You must examine your relationship and life in general. Also, you said "who lacks interest in her husband," not "lacks interest in sex"; there's a difference. Think about whether there are aspects of your marriage that are less than ideal. Often, it is necessary to work with a therapist as well, again one experienced in sexuality.

Decreased libido need not be a life sentence. Evaluation requires being completely open with your doctor or therapist, as well as yourself. Treatment is available for depression, pain and other physical or medical causes. Stress reduction and marital therapy can help if those areas are found to be the likely source of the problem.