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What are some common testosterone products?

Intrinsa, the only testosterone transdermal patch designed for women, is presently available in Europe for the treatment of hypoactive sexual desire disorder; however, it did not gain FDA approval in the United States. Many studies have been performed both locally and nationally. Many women are enjoying rekindled desire by using this product. It is a patch that is placed on the skin avoiding the first-pass mechanism of the liver and thereby minimizing some of the troublesome side effects.

Some of the other testosterones successfully used in women include oral methyl testosterone, transdermal testosterone, topical testosterone propionate cream 2%, testosterone gel, and oral dehydroepiandrosterone (DHEA). There are also medications that combine estrogen and an androgen component (Estratest and Estratest HS). Estratest is typically prescribed for refractory menopausal hot flashes that are not amenable to conventional estrogen replacement treatment.

Testopel is the only FDA-approved implantable cylindrical-shaped testosterone pellet that can be placed in the buttocks as a simple outpatient procedure. Testopels (testosterone pellets) have been used with success in male patients who have hypogonadism or testicular dysfunction. The product has also been used off-label for women with success for the treatment of lowered libido. Three pellets twice yearly can be implanted. Monitoring of serum levels is also needed. If side effects do occur, the implant can be removed as well with ease. A minor in-office procedure can place the pellets, and complications are minimal. Results are promising for improvement in libido.

Libigel is another testosterone product that is presently in stage 3 clinical trials. There are large ongoing trials looking at cardiovascular risk and breast cancer concerns with this new and innovative product. It is a gel that contains testosterone and can be applied to the upper arm. It has shown excellent, promising results for the treatment of hypoactive sexual desire disorder in menopausal women who have had a hysterectomy and are on a stable dose of estrogen. More data and studies should be forthcoming soon.

Testim is an FDA-approved product of testosterone replacement for men that can also be used off-label for women.

It is clear that women who decide to embark on testosterone treatment and who take testosterone off-label in an effort to have increased desire and libido should be under the care of a sexual medicine specialist. You need to have your blood laboratory values monitored closely. Your blood, lipids, and liver should be monitored and any side effects reported immediately to your clinician. If you experience any side effects, the medication should be adjusted. Return of libido should be monitored and you should be monitored for both breast health (mammograms) and cardiovascular health.

How can phosphodiesterase inhibitors (medications such as sildenafil [Viagra], tadalafil [Cialis], and vardenafil [Levitra]) be helpful to women? I thought they were only for men.

Phosphodiesterase inhibitors are medications that have been used in women for the treatment of sexual complaints. Phosphodiesterase inhibitors have been approved for the treatment of erectile dysfunction[1] in men. Numerous attempts have been made to show an efficacy in women, but most fail to show any significant benefit in randomized clinical trials. The proposed mechanism of action is that the medication relaxes the clitoral and vaginal smooth muscle. Some potential side effects include headache, uterine contractions, dizziness, hypotension, myocardial infarction (heart attack), stroke, and sudden death. New and exciting emerging data may support their use in women who suffer from sexual complaints as a result of hypertension, diabetes, neural and vascular disease, or selective serotonin reuptake inhibitor (SSRI) use.

Treating one partner without examining the other is like assembling only half of a jigsaw puzzle.

Recent data suggest that men who use phosphodiesterase inhibitors may actually be helping their spouses achieve sexual satisfaction. In a recent article titled "Through the Eyes of Women: The Partners' Perspective on Tadalafil," which was published in the Journal of Urology in September 2006, Althof and associates attempted to evaluate patient and partner responses to the efficacy and overall satisfaction with use of tadalafil to treat erectile dysfunction. This was a double-blinded placebo controlled 12-week trial of approximately 746 couples, who either received placebo or 10 mg or 20 mg of tadalafil. Female partners of men who were taking the medication reported significantly improved overall sexual satisfaction and corroborated the man's report of erectile improvement and penetration ability. The men were understandably happy and many reported improved erection, penetration, and overall satisfaction with the sexual experience while taking the medication. This study is one of many that examine the couple's response and receptiveness to treatment for erectile dysfunction. It is important to recognize that sexual complaints do not exist in an individual vacuum but rather intricately involve the partner and his or her reaction to treatment.

Treating one partner without examining the other is like assembling only half of a jigsaw puzzle—you may get the fuzzy concept of the picture, but the clear, detailed picture is far from apparent. The concept is that sexual complaints, assessment, treatment, and compliance with therapeutics involve the dyad, the two individuals involved in the intimate relationship. To ignore the sexual partner may limit success in a treatment for a sexual health concern.

  • [1] A persistent or recurrent inability to achieve or maintain an erection sufficient enough to accomplish a desired sexual behavior such as intercourse or coitus; earlier it was described as impotence.
 
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