Posts Tagged ‘Testosterone Pills’


// October 29th, 2010 // 1 Comment » // Hormones

Recognizing that testosterone is the major male hormone and estrogens the hormones of femininity does not mean that gender alone determines exclusive rights to either hormone. Men have small amounts of an estrogen, specifically estradiol, in their bloodstream, and in parallel fashion, women’s adrenal glands and ovaries routinely produce small amounts of testosterone. The exact role of the sex hormones of the opposite sex in people has been something of a mystery, but there is increasing evidence that a man’s estrogens play a role in stimulating prostate gland growth and that testosterone’s presence in a women may be a key factor in maintaining her libido.

Our knowledge of the factors that stimulate or suppress male sexual function, though imperfect, is nonetheless substantially more advanced than our understanding of the hormonal determinants of female sexuality. In adolescent boys, timing of androgen (testosterone) secretion and sexual interest coincide, whereas in young women, androgen secretion and orgasmic capacity are not closely linked. Male hormone production is evident in young girls as early as age ten, when the first wisps of pubic hair appear in response to the increased secretion of the adrenal androgen dehydroepiandrosterone sulfate (DHEA-S), but orgasms are not evident until later. Further, a woman’s androgen levels, both adrenal DHEA and ovarian testosterone, remain fairly constant after the late teens or early twenties, whereas her capacity for orgasms increases steadily.

The best prognosticator of a woman’s sexual activity is her free testosterone level, but this hormone does not appear to influence female sexual behavior as much as cues from peer group women. Adolescent girls tend to be sexually active when their friends are.

Certain androgens such as androstenedione and free testosterone increase just prior to ovulation. This androgen burst coincides with increased sexual activity in all mammals except for the human female, who tends to have an increase in her sexual activity at the conclusion of her menstrual period when her androgens are at their lowest levels.

The pivotal role of testosterone in female libido has not been appreciated until recently and only in those women have had their ovaries surgically removed during a total abdominal hysterectomy. It was at this time that women noted a profound diminution in their sex drive. Initially, popular psychologists ascribed this diminution in libido to despondency over the loss of their uterus and inability to bear children. But women who had a simple hysterectomy with their ovaries left intact did not experience the same sexual fate as their sisters who had both their ovaries and uterus removed. There was something about their remaining ovarian tissue that allowed these women to maintain their libido. Now it appears that that something was testosterone.

Much of our current scientific knowledge about the role of testosterone in female sexuality comes from the extensive studies in Australia and Canada. Only recently has testosterone supplementation for postmenopausal women become popular in this country, and that has been largely due to the efforts of Dr. Susan Rako, a Boston psychiatrist who writes that she became interested in testosterone on her own in 1988 when “her hormones crashed” around the time of her menopause. Traditional HRT to correct her estrogen deficiency, it seems, was not sufficient to correct her “loss of sexual and vital energy.” With testosterone supplementation, she felt better and was energized and revitalized.

Eager to share her experience with others, she published a book entitled The Hormone of Desire: The Truth About Sexuality, Menopause, and Testosterone, extolling the benefits and downplaying the adverse effects of bolstering testosterone levels in postmenopausal women.

The very first reports of testosterone supplementation had indeed focused on postmenopausal women who, like Dr. Rako, complained of a loss of sexual desire while receiving conventional estrogen and progesterone hormone replacement therapy (HRT).

Studies in Australia and Canada relied on a visual analog scale, asking women “On a scale of 0-100 with 100 being entirely normal, how would you rate your sex drive?” before and during treatment. Women scored themselves low at 20 before and 85 after 6 weeks of estrogen plus testosterone, but were unchanged after estrogen alone.

In Canada, Dr. Barbara Sherwin evaluated not just libido but overall sense of well-being, energy, and appetite in postmenopausal women with no ovaries. She found that compared to placebo or estrogen alone, women who received a combination of estrogen and testosterone, this time by intramuscular injection and not by pellet implantation, had a significant improvement in their well-being, energy level, and appetite. This improvement carries a cost, for all of the testosterone-treated women grew hair on their faces and had a worsening of their cholesterol profile, making them theoretically more susceptible to atherosclerosis. Mindful of the need for safer testosterone delivery systems to activate libido without fostering facial hair growth, new testosterone cremes and lotions are being formulated.

Capitalizing on the recent enthusiasm for providing supplemental testosterone to enhance libido in postmenopausal women, some have started to cautiously explore the potential benefit of a combined estrogen and testosterone pill. Reasoning that unsightly facial hair and disordered lipid profiles are dose related, the manufacturers of Estratest, the most common estrogen and testosterone combination pill, have now come out with Estratest-LD, the LD signifying that the pill contains a lower dose of testosterone than the parent compound. However, the testosterone in both pills is methyltestosterone, one of the 17-alkylated testosterone products known to have significant side effects. We do not yet know the benefits of long-term androgen therapy in women, but we do know of some of the reported risks of this treatment. Most of the currently available testosterone in pills may carry a burden of liver toxicity. (See earlier comments on AAS.)

Doctors are still uneasy about issuing a blanket recommendation for testosterone pills for all postmenopausal women with diminished libido. As additional data emerge from placebo-controlled studies, we should be able to learn whether androgen supplementation is not only effective but also a safe treatment for postmenopausal women with low sexual desire and inhibited sexual arousal.

However, a limited trial of testosterone may be precisely what Linda needs. She may do just as well with either testosterone pills or patches to resurrect her lost libido. For example, to circumvent the liver toxicity of testosterone pills, testosterone patches have been used with some success.
The testosterone patches differ in some respects from those used by men both in dose and use. Men have to change their patches daily, but women seem to be able to go three to four days before changing patches. The use of testosterone patches in women is quite new. We will have a better sense of the value of testosterone patches in postmenopausal women when results of additional research studies are made available.


// October 29th, 2010 // No Comments » // Hormones

Testosterone Pills and Injections

Hormone therapy returns sexual function to the vast majority of men with specific disturbances in their body chemistry. The basic principle of any hormone therapy is to re-create a state of hormonal equilibrium. For men with thyroid or adrenal hormone disorders, this can be accomplished with hormone pills. Unfortunately, such is not the case for impotent men with testosterone deficiency.

Testosterone pills are available, but they are less effective than testosterone given by injection. Testosterone pills are not well absorbed from the stomach, and blood testosterone does not always reach useful therapeutic levels. The pills also have a serious side effect — liver damage.

Giving testosterone injections once a week, every two weeks, or even once a month, although effective, causes wide fluctuations in serum testosterone levels, with highest values occurring shortly after injection. Then, with normal metabolism, levels fall until the next injection. This results in a variable sexual response. Adjusting the dose or frequency of testosterone injections smoothes out testosterone levels and maintains a steady state of sexual function.

Testosterone Skin Patches

Prescribing testosterone has, until recently, been fairly prosaic, for doctors had only to choose between the daily administration of a testosterone pill or periodic testosterone injections to maintain normal testosterone levels in the bloodstream of testosterone-deficient men. Testosterone pills had been under a cloud because they were burdened by a legacy of liver toxicity. No comparable problem plagued testosterone injections, but even though they were safe, their effectiveness depended on their being given as deep intramuscular injections every two to three weeks. Although both testosterone pills and injections worked, they were considered to be far from ideal, and scientists started looking for new, less toxic and more convenient ways to provide a man with the testosterone he needed. That is what spurred the development of the testosterone skin patch.

Doctors have been rubbing medications on the skin surface for years with good results, for they knew that blood circulating under the skin and nourishing it would absorb and transport medicine from the skin into the bloodstream. Cigarette smokers eager to stop can go into any drug store and pick up a set of nicotine-impregnated skin patches programmed to deliver progressively decreasing amounts of that drug to help them kick the nicotine habit.

Today postmenopausal women have, at their disposal, a variety of estrogen-containing pills and at least two different types of estrogen skin patches to overcome their diminished estrogen production, but until recently, the production of a testosterone patch seemed to stymie scientists. However, the technical problems that plagued early efforts of testosterone-patch development have been overcome. Today, there are three testosterone skin patches available. They are marketed under the names Testoderm, Androderm, and Testoderm TTS.

All three patches provide a steady supply of testosterone, helping to stabilize serum testosterone levels in testosterone-deficient men, and they avoid the dramatic swings in serum testosterone levels that occur with testosterone injections. However, to maintain their effectiveness, patches must be changed daily and applied properly.