What Do Women Want

the hormone dropped, menopause didn’t actually bring a decrease in testosterone at all; instead, there was a slight rebound. In truth, a steady decline had taken place long before, when a woman was in her twenties and thirties. And the depth of the decline was no worse than what went unnoticed in uncountable women who took the pill.
    Was there a way to make sense of any of this? Was there a way to draw tight links between the physiological—whether something as straightforward as a hormone count or as complex as menopause—and libido? With estrogen, possibly. Around menopause, loss of estrogen led, in some women, to dryness that could undermine desire—even though, if you hooked these women to a plethysmograph and played a pornographic movie, blood raced as it did in far younger subjects. The tissues just weren’t manufacturing as much fluid anymore when the blood flowed in. So the psychological pathways of desire were intact, but the chemical reactions responsible for wetness were impaired. And the tissues themselves could thin. This could lead to obvious problems: if intercourse was uncomfortable, you weren’t likely to want it; if it was downright painful, you would probably avoid it; either way, you might quit thinking about it; desire might be destroyed. Then again, something else was obvious, too: there were any number of other ways to have sex. But a deficit—immeasurable, maybe immense—was at work. Your mind wasn’t going to be hearing the messages of your genitals as well as it once had. And the communication could be tenuous to begin with. Chivers’s experiments had shown this; her subjects could seem deaf to what their genitals were saying. Lubrication was part of the language—with that diminished, the lustful messages might be more muted, the mind less prone to the awareness of desire, the brain and body much less easily caught up in a loop of yearning.
    Yet there was the Australian study: on desire, new relationships trumped menopause, easily. And Goldstein spoke about how readily dryness and atrophy could be treated with estrogen supplements, with low and safe doses. Lubrication was restored, tissues regained health, but libido didn’t revive reliably. Stubbornly, the effects of hormones evaded logic. Sometimes desire seemed to hide itself from science.
    He returned to talking about testosterone. He was among the thousands of doctors who provided it off-label, flouting the spirit if not the letter of the law. He didn’t hesitate to discuss this. He felt he had to do what he could for his patients. Women came to him after being dismissed by their family physicians, by other gynecologists. “If I had a nickel for every time a patient has said that her doctor told her, Just have a glass of wine.” He gave the hormone to women of all ages, though not indiscriminately—he used his own criteria, his own intuition, to try to figure out who it might benefit. He looked for low blood readings of testosterone, poorly predictive though he knew these to be. He weighed the histories he heard during his interviews, listened for the disappearance of erotic dreams. This, in his mind, was a telling sign: the evanescing of sex from the life of the unconscious. He dwelled on the clues he gathered, followed his hunches. He guessed that by proceeding in this way, he helped more than half the women he provided with the hormone. But that left a lot of his patients inexplicably unreached and a lot who didn’t qualify, by his calculus, for this treatment. And it left him reading dreams, practicing medicine by a system that was barely systematic.
    This muddle, this imprecision, this inability to predict, lay within testosterone’s latest struggles with the FDA. In trials with a thousand women, a pharmaceutical company had collected data to back its product, Libigel. The product did seem to work—somewhat. On average, it made desire rise—undramatically. And yet in the trials, a fake gel, a placebo, had aided libido as much as the medicine. Self-persuasion seemed as potent as the drug.
    A round the fire pit or after the school bus, the chatter about Flibanserin was light, filigreed with a joke or two, the way Wendy liked talk to be. Yet with her friends gone, after wine or coffee, she felt something insidious, a helplessness, a foreboding, a sense that she would be unable to protect—to protect what? Not her marriage, not quite that. She trusted that she and her husband would remain together. It was, she