Dear Neil: Given that you are a marriage and family therapist, I am surprised that you seem to know so little about post-menopausal women. Western post-menopausal women—due to stressful lives, bad diet and lack of exercise—end up with endocrine degeneration, which in turn leads to a significant loss of sexual urge. Foreplay doesn’t work, and sex becomes no fun. This can be quickly corrected by measured and monitored doses of natural hormone treatment.

When reading your recent article advising a husband about his wife’s loss of sexual desire, I was very disappointed to note that you didn’t mention this most likely scenario. Hormonal changes should be eliminated as a cause of low sexual interest in post-menopausal women first, not last.

Disappointed in New Zealand

Dear Disappointed: I am printing your letter as a representative of several dozen other letters I have received from readers on this subject, all essentially saying the same thing you are saying.

And you would be right. Especially regarding women who are going through, or who have gone through perimenopause, menopause, estrogen replacement therapy or surgery to remove ovaries. All of those causes reduce a woman’s testosterone level, which she needs for sexual interest and desire.

I know what you’re thinking. You said testosterone, Neil, but you really meant to say estrogen and progesterone, right? Actually, I meant testosterone. As I have said in a previous column, although women need estrogen for lubrication and proper sexual functioning during sex, they need testosterone to feel desire and sexual arousal in the first place.

Most people think of testosterone as what men produce. But in truth, women produce testosterone also, although in far smaller doses than men. Testosterone largely dictates libido in both males and females. Called the hormone of desire, it stimulates sexual interest and sensitivity to sexual stimulation.

The signs of testosterone deficiency in both men and women include decreased sexual desire, decreased sensitivity to sexual stimulation, decreased ability to become sexually aroused and a reduced sense of overall well-being, according to Susan Rako, M.D., author of The Hormone of Desire (Harmon Books). She says that by the age of 40, most women produce at least 50% less testosterone than they did when they were 20—and sometimes dramatically less than that—and that testosterone further decreases from there as we age.

We’re not talking about major doses of testosterone. That would have undesirable side effects for women. We’re talking about replacing testosterone levels a woman once produced when she was younger, to bring her back to the level of libido she had then. In addition, testosterone therapy for women has been shown in studies to increase energy, psychological well-being and bone mass, which helps in the prevention of developing osteoporosis.

If you are a woman in midlife or older, and you’ve noticed a puzzling decrease in sexual interest that is seemingly not related to the quality of your relationship, talk with your doctor or gynecologist about taking testosterone. It can be taken as a pill, a cream or a lozenge. If your libido doesn’t respond to this therapy, try changing the dosage. There are also herbs and natural products as alternatives which may be effective, including natural bio-identical restoration therapy. In addition, it would be prudent to have your estrogen and progesterone levels checked also, because there could be a hormonal imbalance further complicating the problem.

And thank you for keeping me on the ball, thorough and humble.