Androgens in Female Sexual Dysfunction
August 25, 2010
Androgens in Female Sexual Dysfunction
Urdinola Jaime MD
Andes Medical Association - AK 9116 20 CS 326 - Bogotá DC Colombia-Phone 571 / 215 23 00 e-mail: jaimeurdinolamd@gmail.com
Symposium / Luncheon on Women's Health and Menopause - Association Medical Andes - Board Room - First Floor - Wednesday, August 28, 2010
The issue of Androgens in Female Sexual Dysfunction has received much attention in recent times.
The ovary continues to produce androgens after menopause, which have been attributed a role in the behavior of the female libido. Therefore, oforectomizadas women may complain of sexual dysfunction, even if they are adequately estrogenized. Women receiving estrogens not only increase their libido or the pleasure of intercourse, according to survey data available.
studies have been conducted with transdermal testosterone therapy does not, which has shown improvement in libido and sexual frequency, although the cost of supra physiological levels of testosterone. To address this question we have developed a patch that delivers physiologic amounts of testosterone (Intrinsa ® Procter & Gamble Pharmaceuticals, USA), which has not yet been approved by the FDA 1, although presented at the 2 004. The final study was published in 2 005, with 562 surgically menopausal women were recruited in 53 centers in the U.S., Canada and Australia, comparing the efficacy of the optimal dose of 300 mcg testosterone over placebo in terms of changes in sexual function (an end mixed in a variety of sexual activities, including intercourse, masturbation, etc..). Androgen levels rose and no appreciable change in estradiol or estrone. At the end of 24 weeks of the study the difference was significant, p = 0.0003. The episodes entirely satisfactory sexual activity was of 2.10 vs. 0.98 in the placebo group.
A clinical review of 40 years on the subject was published in 2 006 2 . Initial results of studies by the pharmaceutical industry showed only an improvement moderate but statistically significant improvement in libido in surgically menopausal women receiving estrogen. However, the published data are of short duration of 24 weeks, so that concerns about the safety of long-term use, the most important, have not yet been clarified. (Table 1).
Table 1. Potential Adverse Effects of Testosterone Therapy in Women (most patterns do not occur with transdermal)
Adverse Cardiovascular
Vascular function Lipid
Syndrome Polycythemia Hirsutism
metabolic virilization (deepening of voice, clitoromegaly, male pattern alopecia) Hepatotoxicity
Acne Anger and hostility
Breast Cancer? (This requires a long-term studies)
endometrial cancer (this requires a long-term studies)
If it were to approve the patch mentioned above, the recommendation would be a short-term treatment no longer than 24 weeks in women with surgical menopause receiving estrogen and those who submit simultaneously sexual dysfunction (called by some Hypoactive Sexual Desire Disorder or in earlier times in the DSM-IV 2 001, Deficiency Syndrome Women androgen). Other currently recommend the use of oral methyltestosterone tablets, which is not available in Colombia and which must take into account their potential hepatotoxicity.
sexual dysfunction has been associated with hysterectomy, 32 to 37% of women experiencing decreased sexual response, so it has preserved ovaries. Some have suggested that this is due to the absence of the cervix, because many women report that the pressure of the penis on it triggers the mechanism of sexual arousal, given that the vaginal walls are insensitive to this stimulus, but not all studies agree with this hypothesis. Age is also a factor to consider because with the advancement of the status of menopause, the sexual response.
during climacteric ovary contributes to the movement with 50% of the production of testosterone and androstenedione 30%, although many do not consider the ovary as a primary source of androgen production. Surgical menopause does produce a sudden and significant decline in androgen levels.
Nor should we forget the contraindications to this type of therapy (Table 2).
Nor should we forget the contraindications to this type of therapy (Table 2).
Table 2. Contraindications for Androgen Therapy in Women
Absolute Relative
Breastfeeding Pregnancy Moderate Acne Severe Acne Hirsutism Alopecia
moderate androgenic
Polycythemia Hyperlipidemia Metabolic Syndrome Breast Cancer Cancer
/ endometrial hyperplasia
psychiatric disorders can conclude from this brief review, that the decrease androgen levels is a function of age rather than menopause itself, since many women experience increased levels of androgens to reach the early seventies, if you still have your ovaries, thus not being able to be considered as poor of them. Epidemiological studies show no correlation between androgen levels and sexual dysfunction, lack aunándose this sensitive analysis in the lower range for the measurement of androgens in women. There is still a tool, instrument or questionnaire appropriate and universally accepted to assess sexual dysfunction. Although as noted, although published studies conducted over a short time now, and financed and operated by the pharmaceutical industry, demonstrate modest but significant benefits. But although in absolute sexual benefits may seem modest, it must be emphasized that these small changes can have a substantial impact on the lives of these women. The increase in satisfying sexual event just a month can improve the quality of life of a woman, and that improvement should be accepted as valuable.
Finally, a note to ponder. In Colombia there is a pharmaceutical form of a testosterone gel approved by the Invima in 2 004 only for the treatment of male hypogonadism. Globally, the use of this type of gel is also widespread in women with sexual dysfunction, and this indication is not officially approved. But keep in mind the difficulty in standardizing the dose that is desired, not to exceed the physiological levels of testosterone. This results in abuse or accidental overuse. From the point of view of medicine based on evidence and is sparse, this practice is not recommended. References
1 - Simon J, Braunstein G, Nachtigall L, Utian W, Katz M, Miller S, Waldbaum A, Bouchard C, Derzko C, Buch A, Rodenberg C, Lucas J, Davis S. Testosterone Patch Increases Sexual activity and desire in surgically menopausal Women with hypoactive sexual desire disorder.J Clin Endocrinol Metab. 2005, 90:5226-33.
2 - Basari S, Dobs AS. Clinical review: Controversies regarding transdermal androgen therapy in postmenopausal Women. J Clin Endocrinol Metab. 2006; 91:4743-52 .
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