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Real Doctors (Life Makers)  |  Clinical  |  Psychiatry , Pyschology and Behavioral Medicine  |  "Meeting Women's Desire for Desire; Testosterone Fix" « previous next »
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musheera
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Psychiatrist


"Meeting Women's Desire for Desire; Testosterone Fix"
« on: /November/ 16, 2005, 12:05:22 AM »

"Meeting Women's
Desire for Desire; Testosterone Fix Risky, Say Some Experts" by Lynn
Crawford Cook"

Here's the article:

If you could follow gynecologist Jessica Berger-Weiss around in her
Silver
Spring office for a day, you might be surprised by what you hear. Four
to
five times a day, every day, women in their thirties, forties and
fifties
emotionally tell Berger-Weiss about a problem they think is uniquely
theirs:
"Doctor, I just don't have any interest in sex."

Women in midlife are inundated with emotional and physical reasons why
they
can't experience a fulfilling sex life. Who hasn't heard the jokes
about
couples saying so long to sex once they have children? Add in typical
midlife events such as stress, illness, depression, medications,
relationship problems and plain old boredom, and it's no wonder some
middle-aged women have little interest in intimate relations. "Though
loss
of sex drive is unfortunate, it is common -- almost universal," said
Andrew
Goldstein, co-director of the Sexual Wellness Center in Annapolis.

"Libido is very important for a relationship," said Goldstein. "If a
woman
has no desire, the responsibility [for initiating sex] always falls to
her
partner. Of course, partners become very unhappy. They take it
personally.
They feel rejected."

Although many factors contribute to low sexual desire in women,
Goldstein
said that for some there is an underlying biological mechanism at work.
Goldstein is an investigator in a study of Intrinsa, a Procter & Gamble
(P&G) testosterone patch that the company hopes will provide a medical
solution for women's diminished desire. He and many of his colleagues
believe that testosterone can restore sex drive in some women.

Like all hormones, testosterone works by stimulating an area of the
brain,
in this case the area associated with sexual desire. Usually thought of
as a
male hormone, testosterone is produced by women as well, albeit in
small
amounts, beginning at puberty. Women produce testosterone primarily in
their
ovaries with a small amount produced by the adrenal glands. Between the
ages
of 30 and 50, a woman's ovaries gradually shut down in the process
leading
up to menopause. By the time a woman is 40, her testosterone level has
declined by up to 50 percent. After menopause, it drops even further.

Goldstein, Berger-Weiss and dozens of other physicians in the
Washington
area offer testosterone therapy to women seeking to improve their sex
lives.
Although the Food and Drug Administration (FDA) has not approved a
testosterone-only product for women, citing the lack of long-term
safety
data, some physicians prescribe methyltestosterone, an
estrogen-testosterone
combination designed to treat symptoms of menopause. Some, like
Berger-Weiss, refer patients to compounding pharmacies, which make
customized testosterone products.

But is it normal, or even desirable, for a middle-aged woman to have
the
testosterone level of someone much younger?

"It's not natural for it [testosterone] to be there [after a certain
age],"
said James Simon, a clinical professor at George Washington University
Medical School. However, he said, "only in the last 100 years have
women
lived long enough to need hormone therapy. In every other species,
females
die when their reproductive ability goes away. Historically, we don't
know
what 'normal' is," said Simon, who is also involved in the P&G
research.
A Fact of Life?

Low libido is the most common sexual disorder in women, according to
the
1994 National Health and Social Life Survey, in which one in three
female
respondents said they were uninterested in sex. Hypoactive sexual
desire
disorder (HSDD) -- defined as "persistently or recurrently deficient
(or
absent) sexual fantasies and desire for sexual activity" -- has been
listed
in the American Psychiatric Association's Diagnostic and Statistical
Manual
of Mental Disorders (DSM) since 1987.

"Women are raising the issue with their physicians as frequently if not
more
so than men," according to Berger-Weiss.

Numerous studies over the past 20 years have established the
therapeutic
value of testosterone for restoring women's libido. A review of the
research
published in the journal Menopause last year concluded that "certain
types
of testosterone therapy were associated with higher frequency of sexual
activity . . . desire, thoughts and fantasies, arousal, responsiveness,
and
pleasure."

In 2000, the New England Journal of Medicine published the results of
some
of the first studies of the P&G patch, which showed that testosterone
markedly improved sexual function in women whose ovaries had been
surgically
removed. In the past year, several more published studies have shown
significant improvement in the libidos of surgically menopausal women
who
used the patch. So far, there have been no published studies of women
who
have gone through menopause naturally, although P&G is funding research
on
that group.

Last year, the journal published an article showing the patch prompted
substantial improvement in low-libido women who had gone through
natural
menopause. Most recently, Intrinsa was found to slightly improve sexual
function in pre-menopausal women, as published in the journal
Menopause.

Hormones play a critical role in all aspects of reproductive health,
according to Judith Reichman, "Today" show medical correspondent and
author
of "I'm Not in the Mood" (William Morrow & Co., 1998). Women need
estrogen for lubrication and comfort during sex. But they need
testosterone
to feel desire in the first place. With diminished testosterone,
Reichman
said, women don't just lose desire for their partners, they lose desire
for
any partner.

Some women's health advocates oppose the use of pharmaceuticals to
stimulate
sex drive. According to Leonore Tiefer, associate professor at New York
University Medical School, "There are no norms in terms of sexual
desire,
nor could there ever be any." Treating lack of libido with a drug
"causes a
lack of attention to real sexual problems and their sources. Just
because a
chemical produces a response is no reason to think the situation prior
was a
medical condition," she says.
What's the Problem?

For some women, lack of desire is not a problem. Like the late writer
Hunter
S. Thompson, they are glad to finally dismount the "wild stallion"
they've
been riding most of their adult lives and settle down to other
pursuits. But
many who no longer enjoy sexual satisfaction miss it -- a lot.

Jean Atkins, 53, of suburban Maryland, said she lost interest in sex
completely after a hysterectomy and removal of her ovaries three years
ago.
Until that time, sexual desire was a normal part of her life. After the
surgery, she said, "it was the furthest thing from my mind."

Atkins mourned the loss of what had been an important part of her
relationship with her husband. "He was very understanding," she said.
"But
we were both just kind of disappointed." When a friend told her that
P&G's
testosterone patch was being tested in a clinical trial, Atkins jumped
at
the chance to enroll in it.

Now she is welcoming sex back into her life.

"I notice a difference. I think about sex more than I have in years,"
Atkins
said. After completing her part in the study, she learned that she had
received Intrinsa, not the placebo against which it was being compared.
Although she experienced some of the common side effects of
testosterone,
such as an extra facial hair or two, she plans to continue taking
testosterone.
How Much Is Enough?

Blood testosterone levels in women have not been shown to correspond
with
libido. According to Simon, "In men there is a correspondence -- the
more
testosterone, the more erections and sexual thoughts." But while men
may be
more creatures of their hormones, said Simon, "women are very complex"
in
their sexual responses.

Further confounding the issue is that measurements of testosterone are
not
reliable in women. Because women produce so little of the hormone,
testosterone tests, which were developed for men, are not sensitive
enough
to provide an accurate measurement.

In a study published in the July 6 issue of the Journal of the American
Medical Association, researchers in Australia (one of whom receives
funding
from P&G) found no association between low libido and low blood
testosterone
levels. They wrote, "The measurement of serum testosterone . . . in
individuals with low sexual function is not informative and levels of
these
hormones should not be used for the purpose of diagnosing
(testosterone)
insufficiency in women."

In other words, said Simon, with female sexual function, "Treat the
symptom,
not the blood test."
The Hormone of Desire

The 1990s saw several books about the benefits of testosterone for loss
of
sexual desire. "The Hormone of Desire" by Susan Rako (Harmony Books,
1994)
decried the "patronizing, dismissive and irresponsibly uninformed"
attitude
of medical establishment toward the female sex drive.

Reichman created a stir when she appeared on Oprah Winfrey's television
show
with her book "I'm Too Young to Get Old: Health Care for Women Over
Forty"
(Times Books, 1996), and touted testosterone for increasing libido.
Demand
for the product spiked after that broadcast, according to compounding
pharmacists.

That was nearly a decade ago. At the time, Reichman declared a
"revolution"
in testosterone use. But revolutions can be a long time in the making,
and
they seldom come without a battle.

Perceiving a potentially huge market, P&G developed Intrinsa, the first
in a
new class of drugs designed specifically for women's sexual problems.
The
product has been in clinical trials throughout the United States,
Australia
and Europe for more than six years.

Last December, the FDA denied approval of Intrinsa. Testimony from
Tiefer
and others persuaded an advisory panel that there were not enough
long-term
data to prove the product is safe.

In addition, Tiefer says, off-label use of Intrinsa was likely, meaning
physicians would prescribe it in wider populations, such as
pre-menopausal
women and post-menopausal women who still had their ovaries. There are
no
studies of Intrinsa's safety in these women, Tiefer said.

Jan Shifren, director of the Vincent Menopause Program at Massachusetts
General Hospital, is investigating the use of Intrinsa in women who
have
gone through natural menopause. All the women in Shifren's study
expressed
dissatisfaction with their sex lives. Her data show that the
testosterone
patch restored their desire. She presented this research at a meeting
of the
North American Menopause Society last year.

Both the women receiving testosterone and those receiving a placebo
reported
an increase in frequency of intercourse and sexual pleasure.
Researchers can
only speculate as to why this placebo effect occurred -- the desire of
participants to have a better sex life, for example, or improved
communication with their partners.

"We could never assume that this treatment would be suitable for
everyone.
If we see a pre-menopausal woman with low sexual desire, we treat the
other
causes first," says Shifren. "It's not a tablet you take an hour before
you
have sexual relations. It's a hormone designed for long-term use."

And that's precisely what bothers critics like Tiefer. "It was tested
against a placebo for only six months," Tiefer said in a written
statement.
"This is grossly inadequate to evaluate long-term cardiovascular risk
and
rule out worries about breast cancer."

P&G issued a statement in December saying it hopes to work with the FDA
to
provide additional safety data. Until that time, many physicians like
Berger-Weiss are comfortable prescribing compounded testosterone and
combination testosterone-estrogen therapies.
Women Do Care

After more than six years of taking testosterone she obtains from a
compounding pharmacy, Fran Way, 72, a retired nurse practitioner in
Fort
Meyers, Fla., feels better about her whole life. Not only did the
testosterone cream she applies each day restore her desire for
intimacy, she
said, "for me, it even caused the return of sexual dreams and
fantasies."

Way wishes more women were aware of testosterone. "We seem to think
that
women are just bored or dissatisfied with their relationships. I watch
some
of our friends who have been in relationships for a long time. There is
no
seductiveness. It seems they have just settled."

Simon has made a similar observation. "Some in our profession think
that
women don't care [about sex]. We would never say that about a man.
Women do
care more than we think. Women are entitled to a healthy sex life." ?

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