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Estrogen or testosterone for clitoral atrophy: which is better?

Strong, confident, and healthy - these words aren’t typically used to describe the feeling when menopause hits us. But they could and should be. Whether you’re experiencing hot flashes, vaginal dryness, painful sex, or –let’s face it– clitoral atrophy, know that you’re hardly alone in this experience.

Around the time of menopause, many women begin to notice surprising and distressing changes to the clitoris, but very few get the help they need. That’s why our board-certified doctors offer proven treatment to reverse clitoral atrophy with a telehealth visit.

Hot flashes and night sweats will eventually go away. But changes to the skin in and around the vagina are chronic and progressive - and won’t get better with time. 

The one upside to the vaginal problems: if clitoral soreness and clitoral shrinkage are not something you want to accept as your new normal, this is something you have control over. 

If you’re trying to figure out which is the best bet between estrogen and testosterone, then there’s good news: evidence shows hormone-based therapy will give you more lasting results compared to say clitoral exercises, O shots, or vaginal rejuvenation. But there are key differences that you’ll want to understand before committing to either.

Why does menopause cause clitoral atrophy?

The hormone estrogen is among the factors responsible for shaping the tissues in and around the vagina, so post-menopausal women are likely to experience vaginal atrophy simply because these estrogen hormones no longer present to keep the skin healthy.

In fact, more than 9 out of 10 post-menopausal women will experience vaginal atrophy (also known as the genitourinary syndrome of menopause). 

If you’re experiencing this symptom, it might also be accompanied by clitoral soreness, clitoral shrinkage, paper-thin skin, or skin that looks white or dead. Also, tissues that used to be there can appear to be entirely gone. In other words, what’s happening is that the skin that used to be plump and healthy is beginning to shrink and disappear.

The not-so-great news is that once these changes begin, they won’t get better. Vaginal atrophy is a chronic and progressive condition. Once vaginal atrophy starts, it usually doesn’t get better.

The good news, however, is prescription treatment can help restore healthy skin and prevent further changes to the clitoris. But to make sure you get the best results, you’ll want to consider a few factors before committing to a treatment. 

How does Estrogen Work for Clitoral Atrophy?

Backed by decades of clinical studies and endorsements from top medical groups - vaginal estrogen is prescribed to treat vaginal atrophy from menopause. It works to restore the health of the skin in the vagina and vulva - including the clitoris.

Vaginal estrogen therapy is applied directly to the skin in and around the vagina and is available as a cream, ring, or suppository.

Benefits of Estrogen for Clitoral Atrophy

You may benefit from vaginal estrogen if:

  • You are experiencing moderate to severe vaginal dryness from menopause and are not getting results from vaginal moisturizers or lubricants 
  • You want to target the root cause of vaginal atrophy
  • You want to prevent further vaginal atrophy

Evidence shows that vaginal estrogen restores moisture and plumpness to the vaginal tissues and improves the health of the skin. It’s FDA-approved to treat vaginal atrophy - so if you’re concerned about clitoral atrophy and want to reverse it, then generic vaginal estrogen can help. 

Evidence also shows that vaginal estrogen is a safer alternative to hormone replacement therapy. An analysis of data from the Women’s Health Initiative (WHI) trial has found that postmenopausal women who use vaginal estrogen have the same risk of invasive breast cancer, stroke, blood clots, endometrial cancer, and colorectal cancer as women who don’t use vaginal estrogen.

Drawbacks of Estrogen for Clitoral Atrophy

Just like any prescription medication, vaginal estrogen has some side effects and risks. Vaginal estrogen is FDA approved, and the FDA boxed safety warning recommends to take into account the risks of oral estrogen - although these risks of have not been substantiated in vaginal estrogen.

How Does Testosterone Work For Clitoral Atrophy?

Testosterone therapy is not shown to be directly beneficial for clitoral atrophy, although research shows that the hormone testosterone may improve sexual function for post-menopausal women. 

Medical providers may prescribe testosterone as a cream or gel. Testosterone treatments known as bio-identical pellet therapy are increasing in popularity and problems. Neither cream, gel, nor pellets are FDA-approved for use in women.

In a global position statement published in four leading medical journals, the Endocrine Society stated that the only evidence-based use for testosterone is for the treatment of post-menopausal women who have been formally diagnosed with hypoactive sexual desire disorder/dysfunction (HSDD). 

There are a wide variety of factors that can contribute to sexual dysfunction in post-menopausal women. These factors include vaginal dryness, medication side effects, chronic health conditions, loss of a spouse or partner, lack of emotional intimacy, conflict, stress, and mood concerns. 

It’s important to work with a qualified medical provider to identify and address factors contributing to sexual dysfunction before testosterone therapy can be prescribed.

Benefits of Testosterone for Clitoral Atrophy

While testosterone is not directly beneficial for clitoral atrophy, you may benefit from testosterone therapy if:

  • You are postmenopausal, taking estrogen therapy and have a decreased sex drive with no other factors that can be identified.
  • You have reduced sex drive, depression, and fatigue after surgically induced menopause, and estrogen therapy hasn't relieved your symptoms

Drawbacks of Testosterone for Clitoral Atrophy

Side effects of testosterone use can include deepening of voice, loss of hair, and skin acne. Long-term safety information is lacking, so it’s important to discuss the risks and benefits with your provider. 

Whether you choose testosterone or estrogen, make sure to work with a qualified professional, preferably a gynecologist or urologist. Many products are gaining traction that promise to solve a range of concerns related to menopause, so you may be understandably intrigued by anti-aging clinics that claim to solve everything from low libido to hair loss. 

Our takeaway? If vaginal atrophy is your primary concern and you’re choosing between testosterone and estrogen, avoid testosterone treatment and talk to a qualified medical professional about vaginal estrogen. Vaginal estrogen is not available over-the-counter, so you’ll need a prescription from a doctor, like a board-certified doctor here at Interlude.