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| LAST UPDATED : Sep 6th, 2002 - 23:22:38 |
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Female Sexual Dysfunction
The ovaries are a critical source not only of estrogen but also of testosterone and other androgens such as Androstenedione/DHEA. Even in instances where ovaries have been spared on removal of the uterus, their function may be compromised. Currently women are routinely given estrogen supplementation following hysterectomy/oophorectomy if here is no contraindication.But routine testosterone replacement still is not common place. Due to this androgen deficiency many women develop and suffer symptoms that go unrecognized and untreated. Testosterone supplemental therapy for women following hysterectomy not only can improve the quality of their lives in terms of sexual libido, sexual pleasure, and sense of well-being but also improve body habitus and bone density. In my medical practice post-hysterectomy patients are almost uniformly placed on concomittent testosterone replacement with estrogen replacement due to androgen deficiencies so common in these patients. I commonly use a transdermal delivery of testosterone and more recently have been blending in DHT (Dihydrotestosterone) since many peer-reviewed studies over the past several years have demonstrated feeling of "need for sex" correlates positively with free 5-DHT index and free testosterone index. The results are usually a complete turn around in well being and greatly increased libido. I would avoid the use of the common conventional testosterone replacement "estratest" due to high incidence of side effects and the fact that methyltestosterone (which is not a bio-identical hormone and ban in Europe) is potentially liver toxic. References: 1)Fertil Steril 2002 Apr;77 Suppl 4:60-2 Androgen deficiency in the oophorectomized woman "After bilateral oophorectomy, women also appear more likely to experience decreased positive psychological well-being. Studies of both the consequences of oophorectomy and the effects of testosterone replacement are consistent with an important role for androgens in female sexual function and psychological well-being." 2)Fertil Steril 2002 Apr;77 Suppl 4:94-9 Androgen insufficiency in women: summary of critical issues "Based on our current knowledge, it is clear that some women develop symptomatic androgen insufficiency and that androgen replacement therapy has a beneficial effect on libido, sexual satisfaction, quality of life, and bone mineralization. Androgen replacement therapy should be given the same consideration that we give estrogen replacement therapy." 3)J Clin Endocrinol Metab 2000 Feb;85(2):645-51 Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study. "These results demonstrate that the postmenopausal ovary remains a critical source of androgen throughout the lifespan of older women. The clinical consequences of lower testosterone levels years after oophorectomy are unknown. Reconsideration of prophylactic oophorectomy and clinical trials to evaluate the effects of androgen replacement after oophorectomy are needed." 4)J Sex Marital Ther 1999 Jul-Sep;25(3):175-82 Female hypoactive sexual disorder: case studies of physiologic androgen replacement. "A growing body of literature notes the role of androgens in maintaining women's health and emotional well-being. The administration of physiologic levels of testosterone replacement therapy as an adjunct to estrogen replacement requires further investigation. Physiologic androgen replacement is helpful in increasing sexual desire for some women." 5)J Clin Endocrinol Metab 1999 Jun;84(6):1886-91 Androgen replacement in women: a commentary "There is increasing evidence to suggest that many postmenopausal women experience symptoms alleviated by androgen therapy and that such symptoms may be secondary to androgen deficiency. Affected women complain of fatigue, low libido, and diminished well-being, symptoms easily and frequently attributed to psychosocial and environmental factors. When such symptoms occur in the setting of low circulating bioavailable testosterone, testosterone replacement results in significant improvement in symptomatology and, hence, quality of life for the majority of women. Whether the apparent therapeutic effects of testosterone replacement are mediated by testosterone and its metabolite 5alpha- dihydrotestosterone or are a consequence of aromatization to estrogen is not known. Despite the paucity of data regarding its effects, inclusion of testosterone in postmenopausal hormone replacement regimens is not uncommon and is likely to become more widespread with the availability of preparations developed specifically for women." 6)J Sex Marital Ther 2000 Jul-Sep;26(3):269-83 Controlled studies on women presenting with sexual drive disorder: I. Endocrine status. "Associations between endocrine parameters and indices of sexual behavior were examined. In the control group, average daily sexual thoughts correlates positively with total testosterone, free testosterone index, and free 5-DHT. Feeling of "need for sex" correlates positively with free 5-DHT index and free testosterone index. Experience of sexual thoughts correlates with need for sex, and average frequency of masturbation correlates negatively with age. In both groups, average coital frequency correlates with free testosterone index. I hope this helps Warm Regards, Allyn A. Brizel, M.D. Center For Clinical Age Management www.natural-hrt.com © Copyright 2001, All Rights Reserved - Center
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