Although doctors all say psychological wellness and overall health are key components to sexual wellbeing, the consensus seems to be that testosterone is the only proven treatment, among dozens of products being marketed as female libido enhancers.

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Patients may be prescribed topical creams from a compounding pharmacist.

“Testosterone is still what we know to be the most effective,” said Dr. Jane Dimer, an OB-GYN with Group Health Cooperative. But she is cautious about readily prescribing it, stressing that treatment has to be individualized and doctors have to look at the patient’s mind-body connection.

“Women have to feel relaxed, competent and confident,” she said.

As for herbs, there doesn’t seem to be any proven remedies. Best-selling author and naturopath, Dr. Andrew Weil, says on his Web site there is no scientific proof that any herbs work for libido.

“Damiana leaf, the plant most often used as an aphrodisiac for women might be useful, but not that much is known about it,” he wrote.

“Based on what we know now, the only proven way to enhance female sex drive is with the male hormone testosterone, available by prescription.”

In The Hormone of Desire, Massachusetts doctor Susan Rako writes that the female body produces significant amounts of testosterone that are crucial to the healthy functioning of every woman's libido, as well as to the health of her bones and heart. From perimenopause, the levels drop significantly and supplementing testosterone can bring the body back into balance, according to Rako.

She advises women to get prescriptions from their doctors for testosterone cream, obtainable from compounding pharmacies.

The only widely available prescription drug containing testosterone for women is Estratest, a hormone pill that is made up of both estrogen and testosterone, approved 30 years ago. But a recent study, published in the July 24, 2006 Archives of Internal Medicine, found that Estratest doubles the risk of breast cancer in women.

Researchers tracked 70,000 nurses over 30 years and found that those who took estrogen and testosterone for menopausal symptoms had a 2.5 times higher risk of developing breast cancer than women who never took hormones. Those who used only estrogen had an increased risk of 15 percent.

One drug that has shown some promise as a safe libido booster is Tibolone, a drug currently used in Europe and Australia for treatment of postmenopausal symptoms. According to a 2002 study published in the National Library of Medicine: “Tibolone is associated with improvements in sexual function that seem to be greater than those achieved with standard hormone replacement therapy.”

So far the drug hasn't received Food and Drug Administration (FDA) approval for use in the U.S. According to the women’s health Web site Our Bodies Ourselves, Tibolone “combines some of the effects of estrogen, progesterone, and testosterone.

"It is fairly effective for hot flashes and vaginal dryness and very effective for reviving the sex drive. Tibolone is less masculinizing than testosterone and probably provokes less breast cancer and uterine cancer than usual hormone replacement therapy; its effects on heart disease are unknown.”

In the future, Dr. Dimer said designer steroids, like SERMS, offer potential, but the technology is not yet available.

SERMS (selective estrogen-receptor modulators) block the action of estrogen in the breast and certain other tissues by occupying estrogen receptors inside cells. They stabilize bone mass, reduce hot flashes and stimulate libido, but do not have the health risks of estrogen in undesirable ways, the main one being a higher risk for breast cancer.

Meanwhile, Dr. Dimer points to inequality in research and treatment of the female libido.

“Although Viagra is covered for men, the issue of female libido doesn’t fall into same category so medication and counseling are not a covered benefit, with very limited exceptions,” she said. “So who’s going to do testing for the drugs and supplements? The big picture is: it’s hard to get your foot in the door about this issue.”