Decreased Testosterone and ED

Researchers writing in the Journal of Urology say that their study clearly demonstrated a decrease in testosterone level throughout a 4-year follow up in patients with ED.

El-Sakka AI, Hassoba HM. Age related testosterone depletion in patients with erectile dysfunction. J Urol. 2006 Dec;176(6):2589-93.

PURPOSE: We assessed the pattern of age related testosterone depletion in patients with erectile dysfunction.

MATERIALS AND METHODS: A total of 305 patients with erectile dysfunction who had a normal testosterone level at baseline visit and who completed the study were candidates for analysis. Erectile function was assessed using the International Index of Erectile Function. Patients underwent routine laboratory investigations plus total testosterone and prolactin assessment at the baseline visit and on a yearly basis for 4 years.

RESULTS: The mean age +/- SD was significantly higher in 210 patients with decreased testosterone (55.3 +/- 7.3 years) than in 95 patients with steady testosterone (remaining within the normal range) (50.8 +/- 10.2 years).

There was a significant decrease in yearly mean testosterone level throughout the study in all the age groups (determined by decades) older than 30 years.

Of the study population 68.9% had decreases in testosterone levels throughout the 4 years of visits.

Hypogonadism (testosterone lower than normal range) developed in 7.6% of the study population.

There was a significant decrease in mean testosterone at any visit in comparison to previous visits.

There were significant associations between decreased levels of testosterone and increased severity of erectile dysfunction at baseline visit, longer duration and poor metabolic control of diabetes, ischemic heart disease, hyperprolactinemia and low desire.

CONCLUSIONS: This study clearly demonstrated a decrease in testosterone level throughout the 4-year followup in patients with erectile dysfunction. Patients with decreasing testosterone were older than patients with a steady testosterone level.

The Use of Testosterone with Estrogen and Progestogen and It’s Effect on Breast Cell Proliferation

Researchers writing in the medical journal Menopause say “Addition of testosterone may counteract breast cell proliferation as induced by estrogen/progestogen therapy in postmenopausal women.”

Hofling M, Hirschberg A, Skoog L, Tani E, Hagerstrom T, von Schoultz, B. Testosterone inhibits estrogen/progestogen-induced breast cell proliferation in postmenopausal women. Menopause. 13 November 2006

Conclusions: Addition of testosterone may counteract breast cell proliferation as induced by estrogen/progestogen therapy in postmenopausal women.

Women, Testosterone and Cardiovascular Disease

Researchers writing in the medical journal Coronary Artery Disease say that their study “could suggest that the development of cardiovascular disease after menopause is due not only to estrogen decline but also to androgen decline.”

Montalcini T, Gorgone G, Gazzaruso C, Sesti G, Perticone F, Pujia A. Endogenous testosterone and endothelial function in postmenopausal women Coron Artery Dis. 2007 Feb;18(1):9-13.

OBJECTIVE: It is well known that coronary heart disease incidence increases in women after menopause. This phenomenon was related to reduced levels of female sex hormones. Estrogen decline, however, is not the only hormonal change during the postmenopausal period and estrogen administration did not protect women from cardiovascular disease. Therefore, it is justified to explore other hormonal changes. The role of androgens is still controversial. The aim of the present study was to investigate the relationship between endogenous sex hormones and endothelial function, measuring the brachial artery flow-mediated dilation.

METHODS AND RESULTS: Sixty postmenopausal women were consecutively enrolled and underwent a clinical and biochemical examination. Brachial artery flow-mediated dilation was also evaluated by ultrasound. After correction for confounding variables, testosterone was positively correlated to flow-mediated dilation (beta=0.277, P=0.03). Indeed, women in the lowest testosterone tertile had a flow-mediated dilation smaller than that in the highest tertile (P=0.02).

CONCLUSIONS: This result could suggest that the development of cardiovascular disease after menopause is due not only to estrogen decline but also to androgen decline. More studies are needed to evaluate the role of androgen replacement therapy on postmenopausal women with low level of this hormone.

Testosterone in Post Menopausal Women

An article in the medical journal Current Opinion in Obstetrics & Gynecology says that testosterone therapy is a promising option for treating women with HSDD (very low libido or desire)

Somboonporn W.Androgen and menopause.Curr Opin Obstet Gynecol. 2006 Aug;18(4):427-32.

From the article abstract:

PURPOSE OF REVIEW: Androgen therapy is being increasingly used in the management of postmenopausal women. The most common indication is to improve sexual function. The aim of this review is to evaluate current knowledge pertaining to testosterone and sexual function in postmenopausal women.

RECENT FINDINGS: The change of testosterone levels during the menopause transition remains controversial. A correlation of endogenous testosterone levels and sexual function is still inconclusive. A Cochrane Review and recent randomized control trials have, however, consistently demonstrated that short-term testosterone therapy in combination with traditional hormone therapy regimens improves sexual function in postmenopausal women, particularly surgically menopausal women with hypoactive sexual desire disorder.

An adverse effect on the lipid profile has been identified which appears to be mostly associated with oral methyltestosterone. Data for other effects of testosterone and long-terms risks are lacking. Testosterone may act in a variety of ways in different tissues. This is, however, an area that requires further investigation.

SUMMARY: Testosterone therapy is a promising option for treating women with hypoactive sexual desire disorder after surgical menopause. Two remaining questions need to be answer: who is most likely to benefit from testosterone therapy and what are the long-term health risks?

Testosterone For Women Studies and News

Testosterone and Libido in Post Menopausal Women
Researchers writing in the medical journal Gynecological Endocrinology say that there is emerging evidence that androgens are significant independent determinants affecting libido and satisfaction, as well as mood, energy and other components of women’s health.

Testosterone in postmenopausal women
An article in the medical journal Current Opinion in Obstetrics & Gynecology says that testosterone therapy is a promising option for treating women with HSDD (very low libido or desire)

Testosterone enhances libido and decreases depression
Researchers reporting in the Journal of Neuropsychiatry and Clinical Neurosciences say Testosterone enhances libido and decreases depression.

Schutter, et al. J Neuropsychiatry Clin Neurosci.2005; 17: 372-377. Depression Administration of Testosterone Increases Functional Connectivity in a Cortico-Cortical Depression Circuit.

From the abstract: “Increasing evidence suggests that the steroid hormone testosterone (T) enhances libido and decreases depression. Even a single administration of T (0.5 mg sublingually) in healthy young women is sufficient to enhance physiological sexual responsiveness….” Read the abstract

Testosterone For Libido Loss In Women
September 19, 2005’s Washington Post reported “a position statement from the North American Menopause Society (NAMS) and published in its journal, Menopause,” that testosterone therapy may aid many post-menopausal women dealing with loss of libido. You can read the Washington Post article here.

Study: An overview of testosterone deficiency and supplementation in women.
Davis SR, Androgen treatment in women. MJA 1999;170:545-549.

The researchers state: “Women reporting loss of libido may find physicians insufficiently empathetic, and a biological cause for sexual dysfunction in women is rarely sought. However, it is gradually becoming more accepted that androgen deficiency in women may underpin a variety of symptoms and pathophysiological conditions and that, in selected women, androgen replacement therapy is of clinical benefit.”

“Testosterone insufficiency in women: fact or fiction?”
Guay, A, Davis SR. Testosterone insufficiency in women: fact or fiction? World Journal of Urology 2002;20(2):106-10.

The researchers state: “Androgen deficiency is a true medical condition in both pre- and post-menopausal women. The most important recommendation is to listen to the patient and consider androgen deficiency when the symptoms are present, even if they seem non-specific…Treatment with androgens has to be monitored carefully because of the possible harmful effects of excessive levels of testosterone.”

Bone Loss and Testosterone in Women with Anorexia Nervosa
A study is being recruited, Anne Klibanski, M.D., Principal Investigator, by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Center for Research Resources (NCRR) to determine among other things if low dose testosterone will be a benefit in preventing bone loss in women with Anorexia Nervosa.

From the abstract: “Women with Anorexia Nervosa have been found to have low bone density. The study will determine whether administration of low doses of a natural hormone, testosterone and/or risedronate, a medication to help prevent bone breakdown will improve or prevent bone loss in this condition.”

Testosterone Beneficial for Libido and Cholesterol
Researchers reviewing the current medical literature on the role of Testosterone in enhancing libido in post-menopausal women say; “The available evidence is that adding testosterone to estrogen therapy, with or without progestin, appears to be effective in improving sexual function in postmenopausal women and is associated with a reduction in high-density lipoprotein (HDL) cholesterol.”

The findings appear in The Cochrane Library, read the abstract and summary of this article .

HRT, Testosterone and Post Menopausal Women – Problems of Sexual Dysfunction
Researchers writing in the medical journal Maturitas say that HRT along with testosterone supplementation helps postmenopausal women who complain of problems related to intimacy.

Women, Testosterone and Cardiovascular Disease
Researchers writing in the medical journal Coronary Artery Disease say that their study “could suggest that the development of cardiovascular disease after menopause is due not only to estrogen decline but also to androgen decline.”

The Use of Testosterone with Estrogen and Progestogen and Its Effect on Breast Cell Proliferation

Researchers writing in the medical journal Menopause say “Addition of testosterone may counteract breast cell proliferation as induced by estrogen/progestogen therapy in postmenopausal women.”

Testosterone for Women

Testosterone is the male sex hormone, but, it is also an important sex hormone for women. A woman produces testosterone in her ovaries and adrenal glands and obviously produces a lot less than a man because women do not grow the muscles or facial and body hair characteristic of higher testosterone levels.

Girls begin to produce testosterone as they approach puberty for use as a precursor to estrogen. A woman will have peak testosterone levels in her mid-twenties and then suffer a steady decline to half those levels in her forties. In my practice, however, I frequently see some women in their thirties producing an insufficient amount of testosterone (especially after child birth).

Additionally, if a woman has a hysterectomy, testosterone levels can drop quickly and significantly.

Signs of testosterone deficiency in women:
1. Low or no sex drive
2. Lack of energy
3. Obesity, especially abdominal fat
4. Loss of muscle tone
5. Reduced bone mass
6. Increased fracture risk
7. Fatigue
8. Wrinkles
9. Hot flashes despite estrogen therapy

The importance of blood tests
Not all women in perimenopause or menopause will be testosterone deficient. Some of the symptoms listed above could be caused by other hormonal problems or health issues. This is why blood, saliva, or urine testing is so important and why self-medication with “testosterone enhancers” or Testosterone itself based on symptoms alone is dangerous.

We order a blood test for total testosterone, as well as free testosterone. While both levels are important to watch, we want to pay special attention to the “Free Testosterone” reading because it is the active hormone.

When a physician orders a total testosterone reading alone, it is possible to get back a “normal,” “within range” reading on a patient who exhibits clearly defined symptoms for testosterone deficiency. How is this possible?

Because most of the testosterone in the body is linked to proteins, the smaller remaining portion is “free” to make itself available to the cells of the body. Free Testosterone or the lack of it is most responsible for symptoms or alleviation of symptoms associated with testosterone. That is why monitoring its levels are so important in testosterone supplementation therapy.

Many scientific papers, some listed below, have cited the following benefits possible to women taking testosterone.

1. Increased sexual desire
2. Relief of menopausal symptoms
3. Reduction of bone loss / osteoporosis
4. Increased vitality
5. Reduced body fat
6. Improved skin tone by stimulating collagen growth
7. Enhanced “quality of life”

Testosterone supplementation risks
It is important to understand that not all women will benefit from Testosterone supplementation. The goals, realities, and risks of Testosterone supplementation should be discussed, at length, with your physician prior to onset of treatment.