By: Jean Johnson for Fibroids1It’s a given that many post-menopausal women will lose some of their edge when it comes to interest in sex and the continued enjoyment of strong bones and muscles. But when this natural decline occurs in younger women in their reproductive years who have some form of pituitary disease, the old saying “life isn’t fair,” comes to mind. More, given the vague and non-specific nature of the symptoms associated with androgen deficiencies, there has been considerable confusion in accessing treatment.
Historical Misunderstanding Prevents Women from Getting Appropriate Treatment
Indeed androgen deficiency in women has historically received little attention, so much so that there has been little consensus if any as to what a clinical definition of this condition in women might be. Consequently, when women still in their reproductive years encounter the classic symptoms of low androgen: “low libido, blunted motivation, fatigue and lack of well-being, associated with normal plasma levels of estrogen and low levels” of what’s known as “bioavailable testosterone,” physicians can be in a bit of a muddle according to a researcher in the field Susan R. Davis, M.D., Ph.D. of the Women’s Health Program, Department of Medicine, Monash Medical School, Alfred Hospital, Victoria, Australia.
More specifically, in a Medical Journal of Australia article in 1999, Davis noted that since the medical community so poorly understands androgen deficiency, it often attributes the symptoms with which women present to “psychosocial and environmental factors.”
Davis added that “the basis of each of the symptoms listed above is likely to be multifactorial, making it important for treating physicians to evaluate and deal with other factors before considering androgen replacement.”
| Take Action |
Take Home Tips from the 2006 Testosterone Patch Study:
Replacement therapy is generally for women under 50 years of age.
Know that particularly when it comes to low libido, physicians have historically tended to assume that non-biochemical factors are the cause.
Testosterone patches are currently on the market and manufactured by Proctor & Gamble. The company provided the patches for the study but did not support funding in any other way.
Testosterone therapy is only indicated in women with severe androgen deficiencies and hypotuitarism like that seen in pituitary adenoma.
Talking to your doctor is the best way to determine what course of action is right for you. |
It can be tough going for women and the clinicians who treat them, particularly when it comes to diagnosing reasons for diminished sexual function. On the one hand, it would be inaccurate to dismiss the influence of hormones on the emotions of females. On the other, however, passing too much off on emotive factors can be devastating when it comes to women’s health as the recent literature has made clear regarding the area of females, heart disease and misdiagnosis.
Indeed, as Davis wrote in her 1999 update: “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.”
In short it’s a new millennium, and science has progressed over the past seven years since Davis supplied her clinical update.
Testosterone in a Patch?
Enter the testosterone patch that delivers low levels – a prudent 6 percent of a standard male dose – to women with severe androgen deficiency and hypotuitarism. Results published in the May 2006 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM) showed that half of the 51 women in a year-long study of the testosterone patch experienced improved sexual function, increased bone density and larger muscle mass.
“Hypopituitarism in women is characterized by profound androgen deficiency due to a loss of adrenal and/or ovarian function,” Medscape Medical News reported authors of the paper writing. “The effects of testosterone replacement in this population have not been reported… The objective of the study was to determine whether physiologic testosterone replacement improves bone density, body composition, and/or neurobiological function in women with severe androgen deficiency secondary to hypopituitarism.
“This randomized, placebo-controlled protocol is the first to demonstrate increases in bone density and changes in body composition due to physiologic testosterone replacement in a group of women with severe androgen deficiency,” the authors reported. “Moreover, this is the first study to show improvements in mood, sexual function, and quality of life in women with hypotuitarism receiving testosterone therapy.”
The authors added, of course, that given their pioneering work, “Further studies will be needed to determine the long term efficacy and safety of such a replacement strategy.”
Perhaps so, but the testosterone patch study is still very welcome news for women in the reproductive years who have suffered from serious untreated androgen deficiencies. No longer will clinicians who are up to date in their field relegate their patients’ symptoms to non-biological factors. Rather a serious look at testosterone levels will be had and considerations concerning appropriate medical treatment explored.
Androgen/Testosterone Primer
As far as definitions go, here’s one: Androgen is defined as a steroid hormone. Both testosterone and a substance called androsterone are considered androgens or androgenic hormones. These are biochemical agents that control the development and maintenance of masculine characteristics.
In other words, testosterone is a type of androgen. With that cleared up, there’s still the question of why treat women with testosterone. After all, it’s just reasonable health and normal sexual drive we’re after here, not whiskers and a wood chopper stance. As always, though, the Mayo Clinic can be counted on to clarify things.
“Testosterone is the male hormone,’ right?” wrote Michael Born, M.D. for the Mayo Clinic. “Well, yes… and no. Testosterone is the primary reproductive or sexual hormone for men, just as estrogen is for women. However, women also produce small quantities of testosterone from their ovaries and adrenal glands. Despite the fact that normal testosterone levels in women are much lower than in men, the hormone plays an important role in maintaining a woman’s health and well-being.”
Jean D. Wilson, M.D., professor of endocrinology and holder of the Charles Cameron Sprague Distinguished Chair in Biomedical Science at the University of Texas Southwestern Medical Center at Dallas, writing in the Willams Textbook of Endocrinology fine tunes the subject a bit more precisely. Examples of how testosterone influences the body include “enhanced libido, energy, immune function and protection against osteoporosis. On average, the adult male body produces about twenty times the amount of testosterone an adult female's body does.”
Testosterone Patch Gives Benefits but Not Unwanted Side Effects
Indeed, researchers in the current testosterone patch point out that although there was a significant increase in acne in the group of women who were not on the placebo, none of the participants experienced any hirsutism (excessive growth of thick, dark hair) or alopecia (hair loss/baldness).
That’s a good thing since hirsutism is more than a hint of peach fuzz on the upper lip. Rather this condition with the weird name – pronounced her-suit-ism – is the development of excessive dark, coarse body and facial hair in women.
Alopecia, the loss of hair on the scalp and elsewhere on the body, is just as bad. It’s a condition that affects more than 5 million people in the United States alone according to the National Alopecia Areata Foundation.
