Naltrexone Use in Treating Hypersexuality Induced by Dopamine Replacement Therapy: Impact of OPRM1 A/G Polymorphism on Its Effectiveness

Hypersexuality is a well-known adverse side effect of dopamine replacement therapy (DRT), and anti-craving drugs could be an effective therapeutic option. Our aim was to update the knowledge on this issue, particularly on the influence of an Opioid Receptor Mu 1 (OPRM1) genetic polymorphism. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We also analyzed a case of iatrogenic hypersexuality that occurred in a patient treated with DRT. An analysis of the OPRM1 gene was performed on said patient. Our search identified 597 publications, of which only 7 were included in the final data synthesis. All seven publications involved naltrexone use. Five of them were case reports. None of the publications mentioned DRT side effects, nor did they report genetic data. Regarding our case report, the introduction of naltrexone corresponded with the resolution of the patient’s hypersexuality. Moreover, the patient carried the A/G genotype, which has been reported to be associated with a stronger response to naltrexone for patients with an alcohol use disorder. Although studies are inconclusive so far, naltrexone could be an interesting therapeutic option for resistant hypersexuality due to DRT. Carrying the A/G genotype could help explain a good response to treatment.

Long-term Effects of Statins, Blood Pressure-Lowering, and Both on Erectile Function in Persons at Intermediate Risk for Cardiovascular Disease: A Substudy of the Heart Outcomes Prevention Evaluation-3 (HOPE-3) Randomized Controlled Trial

BACKGROUND

It is unclear whether modifying cholesterol, blood pressure, or both affect erectile dysfunction. Also, there are concerns that erectile dysfunction is worsened by common medications used to treat these risk factors. In this study, we evaluated the effect of: (1) cholesterol-lowering with a statin; (2) pharmacologic blood pressure reduction; and (3) their combination, on erectile function.

METHODS

A priori, this was a secondary analysis of the Heart Outcomes Prevention Evaluation-3 (HOPE-3) randomized controlled trial. Men were 55 years of age or older with at least 1 cardiovascular risk factor. Erectile function was measured using the erectile function domain of the International Index of Erectile Function (IIEF-EF) score. Men with incomplete scores, or who did not engage in sexual activity, were excluded. Using a 2 × 2 factorial design, participants were randomized to rosuvastatin (10 mg/d) or placebo, and to candesartan with hydrochlorothiazide (HCTZ; 16 mg/12.5 mg/d; Cand+HCTZ) or placebo. Primary outcome was change in IIEF-EF from baseline to end of study follow-up.

RESULTS

Two thousand one hundred fifty-three men were included; mean age was 61.5 years, and mean follow-up was 5.8 years. Mean IIEF-EF score at baseline was 23.0 (SD 5.6). Least square mean change in the IIEF-EF score did not differ with rosuvastatin compared with placebo (-1.4; standard error [SE], 0.3 vs -1.5; SE, 0.3; P = 0.74), Cand+HCTZ compared with placebo (-1.6; SE, 0.3 vs -1.3; SE, 0.3; P = 0.10), or combination therapy compared with double placebo (P = 0.35).

CONCLUSIONS

Cholesterol-lowering using a statin, and blood pressure-lowering using Cand+HCTZ, either alone or in combination, do not improve or adversely affect erectile function.

Overactive bladder syndrome treatment with ospemifene in menopausal patients with vulvovaginal atrophy: improvement of sexuality?

The aim of this study was to assess the effectiveness of ospemifene in the improvement of sexual function in postmenopausal women with vulvovaginal atrophy (VVA) affected by overactive bladder syndrome (OAB) or urge urinary incontinence (UUI). One hundred five postmenopausal patients with VVA affected by OAB and/or UUI were enrolled for the study. All patients received ospemifene 60 mg for 12 weeks. Clinical examination, 3-d voiding diary and the vaginal health index (VHI) were performed at baseline and at 12 weeks. Patients completed the OAB-Q SF, FSFI, FSDS, and SF-36 questionnaires. The patient's satisfaction was also calculated. After 12 weeks, the reduction of urinary symptoms was observed. The OAB-Q symptoms, OAB-Q (HRQL) score were (55.34 ± 13.54 vs. 23.22 ± 9.76; p < .0001) and (22.45 ± 9.78 vs. 70.56 ± 15.49; p < .0001), before and after treatment. SF-36 questionnaire showed a significant improvement (p < .0001). VHI score increased and the women who regularly practice sexual activity increased after treatment. The total FSFI score increased significantly and the FSDS score changed after 12 weeks (p < .0001). The PGI-I after 12 weeks showed a total success rate of 90.5%. Ospemifene is an effective potential therapy for postmenopausal women with VVA affected by OAB or UUI improving sexual function and quality of life.

Sport and male sexuality

The relationships between sport and sexuality in males are of great social and clinical interest, because of sports and motor activities that highly promote social and sexual relationships. Even if few literature exist, two main questions should be taken into account: whether and how physical exercise and sport positively or negatively influence sexual health and behavior and/or whether and how sexual behavior may affect a sub-sequent sport performance. Physical exercise and sport per se can influence, positively or negatively, the hypothalamic-pituitary-testicular axis function and, consequently, the individual's reproductive and/or sexual health. This depends on individual factors such as genetic and epigenetic ones and on different variables involved in the practice of sport activities (type of sport, intensity and duration of training, doping and drug use and abuse, nutrition, supplements, psychological stress, allostatic load, etc.). If well conducted, motor and sport activities could have beneficial effects on sexual health in males. Among different lifestyle changes, influencing sexual health, regular physical activity is fundamental to antagonize the onset of erectile dysfunction (ED). However, competitive sport can lead both reproductive and/or sexual tract damages and dysfunctions, transient (genital pain, hypoesthesia of the genitalia, hypogonadism, DE, altered sexual drive, etc.) or permanent (hypogonadism, DE, etc.), by acting directly (traumas of the external genitalia, saddle-related disorders in cyclists, etc.) or indirectly (exercise-related hypogonadism, drug abuse, doping, stress, etc.). Sexual activities shortly performed before a sport competition could differently influence sport performance. Due to the few existing data, it is advisable to avoid an absolute pre-competition sexual abstinence.

The Circle of Female Sexual Desire-Have We Come a Long Way?

Ever since the release of sildenafil (Viagra) two decades ago to treat erectile dysfunction in men, there has been a conversation around whether there is a need for a "female Viagra." Last year's release of flibanserin (Addyi) was hailed by some as an achievement in women's sexual health. But how effective is this drug in affecting women's sexual desire? And are the things being labeled as women's sexual desire problems really problems to be fixed with a drug?

Testosterone deficiency syndrome: benefits, risks, and realities associated with testosterone replacement therapy

Testosterone deficiency syndrome, which has sometimes been termed age-related or late-onset hypogonadism, is a syndrome characterized by both clinical manifestations as well as a biochemical deficiency of testosterone. This condition is associated with considerable morbidity and mortality, accounting for billions of dollars in health care costs. There is some evidence that suggests that restoring testosterone levels in these individuals may help to manage or delay progression of the associated morbidities. Furthermore, despite controversies in the literature and media, testosterone replacement has proven to be quite safe in most men with minimal if any adverse effects when dosing to achieve the eugonadal range. It is nevertheless very important for clinicians to be aware of the possible risks and contraindications of treatment to ensure proper patient selection and appropriate monitoring.

Clinical review: The benefits and harms of systemic testosterone therapy in postmenopausal women with normal adrenal function: a systematic review and meta-analysis

CONTEXT

The use of T has been suggested to improve women's health during the postmenopausal period.

OBJECTIVE

We conducted a systematic review and meta-analysis of randomized trials to summarize the best available evidence regarding the benefits and harms of systemic T in postmenopausal women with normal adrenal function.

METHODS

A comprehensive search of MEDLINE, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, EBSCO CINAHL, and Scopus was conducted through January 2014. We conducted study selection, data extraction, and appraisal in duplicate. Random-effects meta-analysis was used to pool results.

RESULTS

We identified 35 randomized trials (n = 5053) at a moderate risk of bias. T use was associated with statistically significant improvement in various domains of sexual function and personal distress in postmenopausal women, although the majority of the trials did not have specific or contemporary diagnostic criteria for androgen deficiency in women. T use was also associated with a reduction in total cholesterol, triglyceride, and high-density lipoprotein and an increase in low-density lipoprotein and in the incidence of acne and hirsutism. No significant effect was noted on anthropometric measures and bone density. Long-term safety data were sparse, and the quality of such evidence was low.

CONCLUSION

Despite the improvement in sexual function associated with T use in postmenopausal women, long-term safety data are lacking.

Clinical review: The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis

CONTEXT

Exogenous dehydroepiandrosterone (DHEA) therapy has been proposed to replenish the depletion of endogenous DHEA and its sulfate form, which occurs with advancing age and is thought to be associated with loss of libido and menopausal symptoms.

OBJECTIVE

We conducted a systematic review and meta-analysis to summarize the evidence supporting the use of systemic DHEA in postmenopausal women with normal adrenal function.

METHODS

We searched MEDLINE, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through January 2014. Pairs of reviewers, working independently, selected studies and extracted data from eligible randomized controlled trials (RCTs). We used the random-effects model to pool across studies and evaluated heterogeneity using the I(2) statistic.

RESULTS

We included 23 RCTs with moderate to high risk of bias enrolling 1188 women. DHEA use was not associated with significant improvement in libido or sexual function (standardized mean difference, 0.35; 95% confidence interval, -0.02 to 0.73; P value = .06; I(2) = 62%). There was also no significant effect of DHEA on serious adverse effects, serum lipids, serum glucose, weight, body mass index, or bone mineral density. This evidence warranted low confidence in the results, mostly due to imprecision, risk of bias, and inconsistency across RCTs.

CONCLUSIONS

Evidence warranting low confidence suggests that DHEA administration does not significantly impact sexual symptoms or selected metabolic markers in postmenopausal women with normal adrenal function.

Impact of an implantable steroid contraceptive (etonogestrel-releasing implant) on quality of life and sexual function: a preliminary study

The aim of the study was to determine the impact of etonogestrel (ENG)-implant used for contraceptive purpose on Quality of life (QoL) and on sexual function (FSF) of healthy Italian women. The Female Sexual Function Index (FSFI) questionnaire and the Short Form-36 (SF-36) validated questionnaire were administered at baseline, 3 and 6 months after insertion of Nexplanon. The implant seems to have a positive impact on QoL after the first three months of therapy. Users showed an improved general health status and physical role status. The implant did not show negative effects on libido and on sexual function. In the first three months of treatment, users experienced a temporary reduction of vitality, mental health, social functioning and emotional role functioning, which seem to disappear after six months of therapy.

[Results of treatment of patients with prostatic adenoma using silodosin based on an assessment of the phenotype of male sexuality]

The article presents the results of treatment of 40 patients with prostatic adenoma using silodosin (urorec) at a dose of 8 mg per day. Patients were divided into three groups according to the phenotype of male sexuality based on author's questionnaire. Evaluation of treatment results was performed after 24-week follow-up period. There was a high therapeutic effect of silodosin in all groups of patients with prostatic adenoma, but the greatest effect in terms of reduction of urination disorders and increases of maximum urinary flow rate was achieved in men with normo- and hyposexuality compared with hypersexual men. The development of ejaculation disorders during treatment with silodosin in patients with prostatic adenoma is less typical for the patients with hypersexual phenotype.

[Sexuality, heart and chocolate]

All along the history, many kinds of magic and aphrodisiac properties were attributed to the chocolate. Because of the presence of certain active substances, cacao and chocolate are supposed to have some potentially beneficial effects on human health, particularly on cardiovascular system. Containing flavoniods, cacao and its products have antioxidant, anti-inflammatory, anti-atherogenic, anti-thrombotic, antihypertensive and neuroprotective effects, as well as influence on insulin sensitivity, vascular endothelial function, and activation of nitric oxide. Other molecules, like methyxantin, biogenic amines and cannabinoid-like fatty acids, may have a psychoactive action. Synergic effect of all these substances could have a positive direct and indirect influence on sexual health and function. Nevertheless, randomized studies are needed to confirm these hypotheses and to elaborate recommendations about cacao consumption.

Adaptation, equivalence, and validation of the changes in sexual functioning questionnaire-drugs in a sample of drug-dependent men

This study aimed to adapt and validate the changes in sexual functioning questionnaire-short form in a sample of drug-dependent men, achieving equivalence. Participants were 301 drug-dependent and 202 non-drug-dependent men took part in this study. The analysis of invariance revealed strong factor equivalence (RMSEA = .06; χ2/df = 2.66 and ΔCFI = -.01) for the 4-factor model (desire, pleasure, arousal, and orgasm). This model has shown the best fit indices. No items showed differential item functioning (ΔR (2) Nagelkerke < .035). Reliability ranged from α = 0.83 for pleasure to α = 0.61 for orgasm. A comparison between the scores of control and experimental participants showed significant differences (CI = 99%) in all the dimensions. Thus, a worse sexual functioning has been observed in the drug consumer group. The adaptation of the Changes in Sexual Functioning Questionnaire-short form to drug-dependent individuals showed good psychometric properties.

A new combination of testosterone and nestorone transdermal gels for male hormonal contraception

CONTEXT

Combinations of testosterone (T) and nestorone (NES; a nonandrogenic progestin) transdermal gels may suppress spermatogenesis and prove appealing to men for contraception.

OBJECTIVE

The objective of the study was to determine the effectiveness of T gel alone or combined with NES gel in suppressing spermatogenesis.

DESIGN AND SETTING

This was a randomized, double-blind, comparator clinical trial conducted at two academic medical centers.

PARTICIPANTS

Ninety-nine healthy male volunteers participated in the study.

INTERVENTIONS

Volunteers were randomized to one of three treatment groups applying daily transdermal gels (group 1: T gel 10 g+NES 0 mg/placebo gel; group 2: T gel 10 g+NES gel 8 mg; group 3: T gel 10 g+NES gel 12 mg).

MAIN OUTCOME VARIABLE

The main outcome variable of the study was the percentage of men whose sperm concentration was suppressed to 1 million/ml or less by 20-24 wk of treatment.

RESULTS

Efficacy data analyses were performed on 56 subjects who adhered to the protocol and completed at least 20 wk of treatment. The percentage of men whose sperm concentration was 1 million/ml or less was significantly higher for T+NES 8 mg (89%, P<0.0001) and T+NES 12 mg (88%, P=0.0002) compared with T+NES 0 mg group (23%). The median serum total and free T concentrations in all groups were maintained within the adult male range throughout the treatment period. Adverse effects were minimal in all groups.

CONCLUSION

A combination of daily NES+T gels suppressed sperm concentration to 1 million/ml or less in 88.5% of men, with minimal adverse effects, and may be further studied as a male transdermal hormonal contraceptive.

[Association of E2v/DNG as contraceptive choice for a better quality of life of women]

The association of estradiol valerate/dienogest (E2V/DNG) is an innovative contraceptive choice with relevant consequences for quality of life of women at all ages. Klaira® (E2V/DNG) combines the use of natural estradiol in a dynamic dosing regimen with a progestin very similar to natural progesterone but with very potent antiproliferative action at the endometrial level. The high contraceptive efficacy of E2V/DNG is associated with a good menstrual cycle control which leads to a novel therapeutic indication in heavy menstrual bleeding. The mild hemostatic and metabolic impact is highly important for women over 35 years, especially when painful syndromes are present (dysmenorrhea and headache), with potential benefits of E2V/DNG, even though the current contraindications of hormonal contraception with ethynilestradiol are still present. In addition, good tolerability and the evidence of beneficial effects on sexual function make E2V/DNG a contraceptive hormonal method with a favourable profile in term of psychophysical well being of women.

[Analysis of variability of cardiac rhythm and sexual function in men with arterial hypertension during therapy with biosporolol and nebivolol]

The aim of the work was to study effect of bisoprolol and nebivolol therapy on the sexual function of men with AH. 20 men aged 35-55 (48 +/- 3.5) yr with grade I and II AH received either drug for 2 months. Cardiac rhythm variability (CRV) was estimated in the end of the 4-week placebo period and after 2-month monotherapy. Dopplerography of penile arteries and a questionnaire study (as described by Vasilchenko) were conducted. Both drugs significantly increased the tone of the parasympathetic component of the vegetative nervous system, improved systolic blood flow in cavernous and dorsal arteries. The questionnaire study failed to revel significant changes of the sexual function. It is concluded that biosporolol and nebivolol did not compromise the sexual function of men with AH; they improve spectral CRV characteristics and blood flow in cavernous arteries.

Effect on sexual function of a vacuum erection device post-prostatectomy

INTRODUCTION

Treatment of erectile dysfunction (ED) subsequent to bilateral nerve sparing robotic prostatectomy (BNSRP) with tadalafil plus a vacuum erection device (VED) may improve return of sexual function.

MATERIALS AND METHODS

Men with prostate cancer who had BNSRP were randomized to receive tadalafil, 20 mg three times weekly, or tadalafil plus a VED, 10 minutes unbanded per day for at least 5 days weekly. Treatments started 1 month after surgery; clinic visits were at 1, 3, 6, 9 and 12 months. Patients were requested to attempt intercourse at least twice before each visit. At every visit patients completed the International Index of Erectile Function (IIEF-5) questionnaire and a penile hardness scale (1-4) and were questioned as to their ability to have vaginal penetration and intercourse to orgasm.

RESULTS

Thirteen men started the combination regimen, and there were no dropouts; 10 patients started the tadalafil treatment, and three men dropped out. The mean IIEF-5 at months 6, 9 and 12 were significantly higher for the combination group, while the penile hardness scores were significantly greater for the combination group at 6 and 9 months. After 12 months 92% of combination patients responded yes to the vaginal penetration question versus 57% of the tadalafil group; corresponding figures were 92% and 29%, respectively, for intercourse to orgasm. Compliance to the VED was superior to that of tadalafil.

CONCLUSION

Men with ED subsequent to BNSRP had a more rapid and complete return of sexual function when treated with tadalafil plus VED versus tadalafil alone.

Women's sexual arousal: effects of high alcohol dosages and self-control instructions

The basic relationship between alcohol and women's sexual arousal - especially genital arousal - received little research attention for nearly 30 years (e.g. Wilson and Lawson, 1978) until very recently (e.g. George et al., 2009). To investigate hypotheses based on earlier findings and Alcohol Myopia Theory (AMT), two experiments evaluated the effects of high blood alcohol concentrations (BACs) and arousal instructional demands on indices of vaginal responding and self-reported sexual arousal. In Experiment 1, self-control instructions to maximize (versus suppress) arousal increased peak and average Vaginal Pulse Amplitude (VPA) change. Self-control also interacted with a target BAC of .08% (versus .00%) to influence latency to peak arousal onset: Intoxicated women instructed to maximize showed a shorter latency to peak arousal than did intoxicated women instructed to suppress; however, sober women showed an undifferentiated pattern. Also, in Experiment 1, the target BAC of .08% had no effect on VPA or subjective arousal measures. In Experiment 2, a target BAC of .10% (versus .00%) attenuated peak change and average change in VPA, but this dosage had no effects on latency to peak achieved arousal, or on subjective arousal. Instructions to maximize arousal (versus no instruction) had no effect on any arousal measures. Overall, among young moderate drinking women, alcohol had attenuating effects but only at the higher dosage. Maximize versus suppress instructions about arousal had predicted effects on arousal and interactive effects on latency, but only at the lower dosage. The findings highlight the importance of dosage and contextual factors in alcohol's impact on the variability of women's sexual responding.

[Comprehensive management for women with epilepsy]

Medical treatment of epilepsy is quite different for women than for men. It is known that estrogen facilitates while progesterone inhibits the generation of epileptic seizures. Due to the direct neuronal effects of estrogen, progesterone, and their metabolites, as well as the cyclic nature of sex hormone release, women are particularly susceptible to the effects of these hormones on seizure frequency and severity. Antiepileptic drugs (AEDs) may result in reproductive endocrine disorders, inhibition of sexuality, decrease in oral contraceptive effects, or congenital malformations. Results of a systematic literature review suggest that the overall incidence of the congenital malformations in children born to women with epilepsy is approximately three times that of healthy women. The risk is elevated in all patients receiving AED monotherapy and further elevated in those receiving AED polytherapy compared to women without epilepsy. Studies have shown that many of these risks can be minimized with appropriate treatment and preconception counseling. The present review article summarizes the comprehensive management of women with epilepsy from a bio-psycho-socio-ethical point of view.

Impact of hypertension on sexual function in women

BACKGROUND

the effect of hypertension and its treatment on female sexual function is largely unexplored especially in Africa. However in practice, cases abound where consequent sexual dysfunction leads to poor or non-adherence with catastrophic results. Believing that like in males, hypertension and its treatment should affect female sexual function; we set out using a structured questionnaire to study the subject as it affects women.

OBJECTIVE

to examine the relationship between hypertension and female sexual functions of arousal, lubrication and orgasm.

METHODS

five hundred questionnaires were distributed to consenting Nigerian women after ethical clearance was obtained. Information sought included demographics, menstrual history, medical treatment and sexual function.

RESULTS

a total of 454 returned questionnaires were analysable. Out of this, 109(24%) admitted to being hypertensive, 89 of whom were on treatment. Hypertension was related to difficulty with sustaining sexual excitement (p=0.03), decreased sexual thoughts (p=0.003), poor rating of marriages (p=0.03), difficulty being excited by fantasies (p=0.0001), increased vaginal dryness in the preceding one year (p=0.02), reduced frequency of sexual contact in the last one year (p=0.04) and rejection of partner sexual advance (p=0.05). The proportion of women in regular sexual relationship was less among the hypertensive group (p=0.02). Use of drugs produced significant sexual unpleasantness (p=0.03).

CONCLUSION

hypertension and its treatment may produce female sexual dysfunction, and should be considered in managing the female hypertensive. By so doing, quality of life can be maintained; and compliance improved upon. The cumulative effect would be improvement in blood pressure control, with its attendant reduction in morbidity and mortality from hypertension.

[Treatment with carnitine, acetyl carnitine, L-arginine and ginseng improves sperm motility and sexual health in men with asthenopermia]

AIM

Among the factors contributing to male infertility, asthenospermia constitutes both a health and a social problem frequently associated with alterations in sexual function. Studies have shown that acetyl carnitine and L-arginine improve sperm motility and that ginseng enhances libido and sexual performance. This study examined the effect of treatment with carnitine, acetyl carnitine, L-arginine and ginseng in men with idiopathic asthenospermia and altered sexual function.

METHODS

The study population was 180 patients with asthenospermia randomly assigned to two groups: group A (90 men) received treatment and group B (90 men) did not. The sperm count was 16.6 ± 3.2 x 10⁶/mL and the total sperm motility was 26.5 ± 3.4%.

RESULTS AND CONCLUSION

Sexual satisfaction was measured using the sexual satisfaction index (SSI). At the end of therapy, a significant improvement was observed in progressive sperm motility on spermiogram evaluation and in SSI scores in the treatment group.

The effect of the weak androgen oxandrolone on psychological and behavioral characteristics in growth hormone-treated girls with Turner syndrome

The weak androgen oxandrolone (Ox) increases height gain in growth-hormone (GH) treated girls with Turner syndrome (TS), but may also give rise to virilizing side effects. To assess the effect of Ox, at a conventional and low dosage, on behavior, aggression, romantic and sexual interest, mood, and gender role in GH-treated girls with TS, a randomized, placebo-controlled, double-blind study was conducted. 133 patients were treated with GH (1.33 mg/m(2)/d) from baseline, combined with placebo (Pl), Ox 0.03 mg/kg/d, or Ox 0.06 mg/kg/d from the age of eight, and with estrogens from the age of 12. The child behavior checklist (CBCL), Junior Dutch Personality Questionnaire (DPQ-J), State-subscale of the Spielberger's State-Trait Anger Scale, Romantic and Sexual Interest Questionnaire, Mood Questionnaire, and Gender Role Questionnaire were filled out before, during, and after discontinuing Ox/Pl. The changes during Ox/Pl therapy were not significantly different between the dosage groups. In untreated patients, the mean CBCL total (P=0.002) and internalizing (P=0.003) T scores, as well as the mean DPQ-J social inadequacy SD score (SDS) (P=0.004) were higher than in reference girls, but decreased during GH+Ox/Pl therapy (P<0.001, P=0.05, P<0.001, respectively). Whereas the mean total (P=0.01) and internalizing (P<0.001) T score remained relatively high, the mean social inadequacy SDS became comparable with reference values. We conclude that in GH-treated girls with TS, Ox 0.03 mg/kg/d or 0.06 mg/kg/d does not cause evident psychological virilizing side effects. Problem behavior, frequently present in untreated girls with TS, decreases during therapy, but total and internalizing problem behavior remain increased.

Not enough said

Although the hormonal effects of antipsychotics are well known to healthcare professionals, they are not always discussed with women.

Chios mastic, a natural supplement for zinc to enhance male sexuality and prostate function

Mastic is a natural resin extracted from the stem of the evergreen tree Pistacia lentiscus var. Chia (Duham) (Anacardiaceae). For a long time, mastic has been esteemed for its aphrodisiac properties. To test this hypothesis, the trace element zinc was determined while the quantity released after a certain time of chewing was studied. For comparison, three commercial chewing-gums were analyzed as well. A portion of natural mastic or commercial gum was uniformly chewed for 1, 2, 3, and 4 h and the zinc content measured. The zinc content of mastic from P. lentiscus var. Chia was compared to that of other natural resins from the same genus (Pistacia terebinthus L.) or conifer [Pinus halepensis Mill. (Pinaceae)], having a different secretion mechanism and also used as an additive in human nutrition. Secreted resin and plant tissues from the above trees were sampled and the zinc content was determined. Zinc concentrations in the resin were lower than in the plant tissues. The Chios mastic showed a slightly greater zinc content compared to the other analyzed specimens. Among all gums studied, only the Chios mastic released a small amount of about 0.7 mg kg(-1) zinc in the mouth and gastrointestinal system after 4 h chewing time. With commercial gums, the zinc content increased to a large degree (up to 2 mg kg(-1)) after the same treatment, a fact which was attributed to the zinc uptake from salivary secretions, indicating zinc deprivation for the human organism.

Timetable of effects of testosterone administration to hypogonadal men on variables of sex and mood

INTRODUCTION

The effects of testosterone have been extensively characterized, but little attention has been given to the timetable of occurrence of the various effects of testosterone.

METHODS

The timetables of effects on sexual and psychological variables in 40 hypogonadal men receiving treatment with either parenteral testosterone enanthate (TE) or undecanoate (TU).

RESULTS

Sexual thoughts/fantasies and sexual interest/desire/spontaneous morning erections emerged quickly and plateaued after 3 weeks. Total erections rose to a maximum over 9 weeks and then plateaued. Ejaculations per week/satisfaction with sex life rose over the first 3 weeks, increasing steadily to a plateau at 12 weeks. Depression scores decreased to reach a plateau after 6 weeks. Aggressiveness did not change. Scores of concentration improved and reached a plateau after 3 weeks in the group treated with TE and after 9 weeks in the group treated with TU. Good mood improved after 6-9 weeks. Positive effects on self-confidence appeared between 3-6 weeks and on fatigue after 9-12 weeks.

CONCLUSION

Insight into the emergence of effects may be useful information for the patient and for the attending physician in monitoring clinical effects of testosterone treatment of hypogonadal men.

Testosterone replacement therapy in the climacteric: benefits beyond sexuality

Testosterone therapy during menopause has a wide range of benefits that reach beyond the realm of human sexuality. This is a consequence not only of the widespread distribution of androgen receptors in various extragonadal tissues but also of the conversion of androgens to estrogens in the tissues in which aromatase expression is present. For this reason, testosterone therapy during the climacteric years will not only supply androgens but will also stimulate estrogen production in tissues that express aromatase. Furthermore, the bioavailability of androgens to the tissues depends not only on the rate of their production by the postmenopausal ovaries and adrenals but also on the circulating levels of sex hormone-binding globulin (SHBG). Tibolone inhibits SHBG production in the liver, thus increasing free testosterone levels. The association of tibolone with testosterone as a form of androgen replacement therapy during the climacteric is discussed, as is the use of low-dose testosterone, tibolone or the association of both in perimenopausal patients with signs of androgen deficiency. Testosterone treatment has a boosting effect not only on human sexuality but also on the sensation of well-being, a stimulatory effect conferred by the increase in beta-endorphins.

Cimicifuga racemosa treatment and health related quality of life in post-menopausal Spanish women

OBJECTIVE

The effect of Cimicifuga racemosa (CR) treatment was evaluated in healthy symptomatic post-menopausal women using the Cervantes health-related quality of life (HR-QoL) scale.

DESIGN

A prospective observational study was carried out in 122 healthy symptomatic post-menopausal Spanish women with elevated body weight, aged between 45 and 59 years. Three groups were formed according to age intervals. Each patient completed the Cervantes HR-QoL scale before and after CR treatment (20 mg, twice a day for 3 months). Changes in Cervantes scale global quality of life scores as well as in their domains (menopause and health, psychic, sexuality and couple relationship) were analysed.

RESULTS

The CR treatment ameliorated global quality of life in both the whole group of patients and when women were analysed by age subgroups. There were significant positive changes in Z scores for the Cervantes HR-QoL scale 'menopause and health', and 'psychic' domains in both the entire population and by age groups. The 'sexuality domain' significantly improved when the entire population was assessed, but not when each age-group was separately analysed; while there were no changes in 'couple relationship domain' scores.

CONCLUSION

CR treatment increased both global quality of life and the four domains of the Cervantes HR-QoL scale, being an effective treatment to reduce symptoms in post-menopausal woman with elevated body weight.

[Information letter "On necessity of wider genetic research in evaluating influence of chemicals on workers' sexual function"]

The author demonstrates own research data and literature review to justify a necessity of wider genetic research in evaluating influence of chemicals on workers' sexual function.

[Peculiarities of neuroleptic syndrome in women treated with typical and atypical neuroleptics]

Tolerability of haloperidol, clozapine and risperidone has been studied in 60 women with different psychiatric disorders including schizophrenia (83,2%) and neurotic disorders (16,7%). A spectrum of neurological, mental and somatic side-effects was different in the treatment with typical (haloperidol) and atypical (clozapine and risperidone) antipsychotics. The treatment with haloperidol more often results in movement disorders, sleepiness, inhibition, sexual dysfunction and cholinolytic effects. Sedative effects, reduced sexual drive, somatic-autonomic symptoms (hypersalivation, constipations, dry mouth, orthostatic symptoms, tachycardia), and metabolic endocrine effects (weight gain) were the most characteristic side-effects for clozapine. Risperidone caused less intensive extrapyramidal and somatic-autonomous symptoms but more expressed metabolic endocrine disturbances (weight gain, galactorrhea, menstrual cycle dysfunction). Comparing to clozapine, side effects of risperidone were represented by the less intensive somatic-autonomous symptoms but more intensive weight gain, menstrual dysfunction and galactorrhea. Based on the previous results of the study of men, the authors conclude that frequency and intensity of neuroleptic side-effects are sex-related that should be taken into account in the choice of antipsychotics.

Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder?

Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children/adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child's quality of life and even save his or her life, then it is indeed unethical to defer treatment.

Psychosocial impact and effectiveness of tadalafil among treatment-naïve and previously-treated men with erectile dysfunction in Saudi Arabia and other Gulf-region countries

OBJECTIVE

This observational, comparative study, conducted in Saudi Arabia, Kuwait, and the United Arab Emirates, assessed psychosocial and efficacy outcomes of tadalafil 20 mg on demand, over a period of 20 weeks, in men with erectile dysfunction (ED) who were treatment-naïve versus pretreated with an ED treatment other than tadalafil.

METHODS

The short form of the Psychological and Interpersonal Relationship Scales (SF-PAIRS) was used to assess psychosocial outcomes (Time Concerns, Spontaneity, and Sexual Self-Confidence). Change from baseline in the International Index of Erectile Function (IIEF) erectile function (EF) domain score was used to assess effectiveness, and Global Assessment Question (GAQ) was asked to determine improvement in erections.

RESULTS

Of 1080 patients analyzed, 557 (51.6%) were treatment-naïve and 523 (48.4%) were pretreated. In all, 500 (89.8%) treatment-naïve men and 473 (90.4%) pretreated men completed the study. Some statistically significant differences were observed in baseline characteristics between treatment-naïve and pretreated groups, including ED etiology, ED severity, duration of ED, and the presence of cormorbid cardiovascular disease, other vascular disease, and neurological disease. Adjusted mean SF-PAIRS Time Concerns domain score was significantly more improved, while the Sexual Self-Confidence domain score was significantly less improved, for the pretreated group compared with the treatment-naive group (both p<0.0001). No significant difference was observed for the Spontaneity domain. The mean change in IIEF-ED domain score for the treatment-naïve group was 13.26 compared with 9.28 for the pretreated group (p<0.0001). Positive responses to GAQ at the last assessment were observed in 97.3% of treatment-naïve men and 94.4% of pretreated men (p<0.0263).

CONCLUSION

This large, observational study in the Gulf region demonstrates that ED patients treated with tadalafil in a naturalistic setting, report improvements in both psychosocial outcomes and erectile function, with some differences between the treatment-naïve and pretreated groups. The results of this study may assist physicians in tailoring tadalafil therapy and setting realistic treatment expectations.

The effect of 5alpha-reductase inhibition with dutasteride and finasteride on bone mineral density, serum lipoproteins, hemoglobin, prostate specific antigen and sexual function in healthy young men

PURPOSE

Dutasteride and finasteride are 5alpha-reductase inhibitors that dramatically decrease serum levels of dihydrotestosterone. Because androgens affect bone, lipids, hematopoiesis, prostate and sexual function, we determined the impact of 5alpha-reductase inhibitors on these end points.

MATERIALS AND METHODS

We conducted a randomized, double-blinded, placebo controlled trial of 99 men 18 to 55 years old randomly assigned to receive 0.5 mg dutasteride (33), 5 mg finasteride (34) or placebo (32) daily for 1 year. Bone mineral density was measured at baseline, after 1 year of treatment and 6 months after drug discontinuation. In addition, markers of bone turnover, fasting serum lipoprotein concentrations, hemoglobin and prostate specific antigen were measured at baseline, after 26 and 52 weeks of treatment, and again 24 weeks after drug discontinuation. Sexual function was assessed at these points by a validated questionnaire.

RESULTS

Significant suppression of circulating dihydrotestosterone levels with the administration of dutasteride or finasteride did not significantly affect bone mineral density or markers of bone metabolism. Similarly serum lipoproteins and hemoglobin were unaffected. Serum prostate specific antigen and self-assessed sexual function decreased slightly during treatment with both 5alpha-reductase inhibitors but returned to baseline during followup.

CONCLUSIONS

Profound suppression of circulating serum dihydrotestosterone induced by 5alpha-reductase inhibitors during 1 year does not adversely impact bone, serum lipoproteins or hemoglobin, and has a minimal, reversible effect on serum prostate specific antigen and sexual function in normal men. Circulating dihydrotestosterone does not appear to have a clinically significant role in modulating bone mass, hematopoiesis or lipid metabolism in normal men.

[Sexual dysfunction in men with spinal injuries]

BACKGROUND

Spinal injuries may disturb men's sexual functions in various ways.

MATERIAL AND METHODS

Review article based on extensive clinical experience, lecturing, research and selected articles.

RESULTS AND INTERPRETATION

A spinal injury may disrupt or disturb the connection between the brain's main centres for sexual function to the genitals. This often leads to extensive problems with erection, ejaculation, orgasm and fertility. Hormonal affection of sexuality is not much altered. Libido problems are of a more psychological nature, such as a poor self-esteem and lack of understanding from the surroundings. Sedative effects of medicines affect all aspects of sexuality. About 80% of men with spinal injuries have erection problems; mainly erection of short duration that can be treated with medicines administered orally (such as phosphodiesterase inhibitors) or by self injection of alpha-adrenergic inhibitors directly into the sinusoids in the penis. Only 10-15% ejaculate spontaneously. Ejaculation may be assisted in various ways, the vibro-ejaculation method being the most effective. The semen quality is reduced, possibly because of altered neurogen control of sperm maturation. Modern techniques for in vitro fertilisation combined with assisted ejaculation and careful control of the semen quality, has made it possible for most spinal-injured men to have their own children.

Flaccid theory and the geographies of sexual health in the age of Viagra™

The discipline of geography is largely absent in discussions and debates about drug use practices and their relationships to sexual health. Given the important relationships among the use of drugs, performances of sexualized identities, and the practices of sex, it behooves medical and health geographers particularly, and social and cultural geographers more generally, to engage in the wider interdisciplinary debates about these relationships. Through a discussion of one drug, Viagra, this brief intervention offers an agenda for studying the geographies of sex, sexuality, and drug use. It is argued that drug use is an inherently geographic practice that reshapes how places are resituated in relation to the fluid and dynamic meanings of sex, sexuality, and sexual health, areas of research and practice that medical and health geographers ought to consider more seriously.

Female sexual dissatisfaction: hormone therapy inappropriate

(1) The causes of sexual dissatisfaction are as complex as sexuality itself. Relationships, cultural, psychological, medical and other factors can all have an influence. This review examines whether hormone therapy is appropriate for postmenopausal women seeking help with sexual dissatisfaction. We conducted a review of the literature based on standardised Prescrire methodology. (2) There are no sexual norms. Treatments proposed for female sexual dissatisfaction have only been assessed according to a mechanical, standardised approach, with little relevance to women's expressed needs. Relationship problems and personal inhibitions are the principal factors contributing to sexual dissatisfaction in surveys of women's sexuality. (3) The decline in testosterone production linked to the menopause does not correlate with sexual dissatisfaction. (4) Hormone therapy has not proven to be effective for female sexual dissatisfaction. Oestrogen improves vaginal dryness, but lubricant gels are just as effective. It is better to help women understand the reasons for their dissatisfaction than to expose them to the adverse effects of hormone therapy.

The impact of the use of PDE5 inhibitors for erectile dysfunction on the lives of Australian men

This article presents findings from a recent cross-sectional study that was designed to evaluate both the impact of erectile dysfunction (ED) on the lives of Australian men, and explore whether the use of PDE5 inhibitors was able to alter this impact. The sample comprised 410 men with ED, and 242 men who did not have ED. All men were primarily recruited over the internet via men's health web sites. Participants completed a questionnaire to assess their self-esteem, masculinity, quality of life, sexual satisfaction, relationship satisfaction and usage of oral ED medication. The results demonstrated that men with ED experienced deficits on all of the psychosocial areas when compared to men without ED. Moreover, treatment with ED medication did not alleviate this deficit. Implications of these findings for the treatment of men with ED are discussed in the context of the biopsychosocial model of health and the need for a multidisciplinary approach to ED management is highlighted.

Transdermal testosterone gel increases serum testosterone levels in hypogonadal men in Taiwan with improvements in sexual function

A randomized, double-blind, placebo-controlled trial was conducted to (1) evaluate efficacy and safety of transdermal testosterone gel (AndroGel) for hypogonadal men in Taiwan, and (2) observe improvements in sexual function through international index of erectile function (IIEF) scores. Eligible hypogonadal men were randomized to receive 50 mg/day transdermal testosterone gel (TTG) or placebo for 3 months. Primary end point was change from baseline in total testosterone (TT) and free testosterone (FT). Secondary end points were change from baseline in serum hormone levels (such as dihydrotestosterone (DHT), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and sex-hormone-binding globulin (SHBG)) and changes in IIEF scores. Safety evaluations included adverse events (AEs) and skin irritation assessment. Compared with baseline, the TTG group (n=20) had statistically significant increases in mean TT levels at month 1 (P=0.024) and month 2 (P=0.025), but no significant changes at month 3. TT levels in the placebo group (n=18) showed no statistically significant change at any visit. Changes in FT levels paralleled changes in TT levels in both groups. TTG group IIEF scores were significantly increased at month 3 (P=0.01), compared with a decline in placebo scores. No drug-related AEs occurred in the TTG group; the placebo group had 2 AEs (mild skin rash). In conclusion, TTG effectively restores serum TT and FT levels to a normal physiological range for hypogonadal men in Taiwan and improves sexual function.

Sexual Function is a Determinant of Poor Quality of Life for Women With Treatment Refractory Interstitial Cystitis

PURPOSE

Interstitial cystitis significantly negatively impacts quality of life. The demographic and clinical factors associated with decreased quality of life in these patients have not been well studied.

MATERIALS AND METHODS

Women with moderate/severe interstitial cystitis enrolled in a clinical trial of intravesical bacillus Calmette-Guerin were studied. Demographic data and responses to questionnaires were evaluated at baseline, including the O'Leary-Sant Interstitial Cystitis Symptom Index and Problem Index, University of Wisconsin Interstitial Cystitis Inventory, Medical Outcomes Study sexual functioning scale, and the physical composite and mental composite scales of the Medical Outcomes Study Short Form Health Status Survey. Three composite indexes were constructed (from the O'Leary-Sant Interstitial Cystitis Symptom Index, O'Leary-Sant Interstitial Cystitis Problem Index, pain/urgency Likert scales and 24-hour voiding diary) to document the severity, frequency and bother of pain, urinary urgency and frequency (frequency composite index). Linear and multivariate regression models were used to examine predictors of the physical composite and mental composite scales of the Medical Outcomes Study Short Form Health Status Survey. Medical Outcomes Study sexual functioning scale data were available for 163 of the 217 women in the trial.

RESULTS

Physical composite scale (median 36) and mental composite scale (median 42) were lower than the standard population value of 50. Multivariate models showed that employment, pain composite index and Medical Outcomes Study sexual functioning scale (all p<0.001) predicted physical composite scale, while only Medical Outcomes Study sexual functioning scale (p<0.001) remained a strong predictor of mental composite scale.

CONCLUSIONS

Sexual functioning, employment and pain issues predict mental and physical quality of life. In particular, this study identifies sexual functioning as a primary predictor of mental quality of life in women with long-standing interstitial cystitis. It is suggested that sexual functioning may be a salient therapeutic target in the multifaceted treatment of patients with interstitial cystitis.

Does oral contraceptive-induced reduction in free testosterone adversely affect the sexuality or mood of women?

The aim of this study was to examine whether changes in plasma androgen levels (total testosterone (T), free testosterone (FT), and dehydro-epiandrosterone-sulfate (DHEA-S)) induced by oral contraceptive (OC) use were related to changes in sexual interest or response or in mood. Sixty-one women provided blood samples and were assessed, using interviews and standardized questionnaires, prior to starting, and after 3 months on OCs (Ortho-Tricyclen, Ortho-Tricyclen-Lo, or Ortho-Cyclen, all containing the same progestagen, norgestimate). Significant decreases in T, FT, and DHEA-S were found after 3 months, although the extent of reduction was variable across women. There was some support for a relationship between the degree of reduction in total T and FT and the frequency of sexual thoughts after 3 months on OCs. However, some women had no loss of sexual interest in spite of substantial reduction in FT, and there was overall no evidence that reduction in FT affected enjoyment of sexual activity with a partner. The findings are consistent with the idea that some women may be more sensitive to changes in T than others. No relationship was found between negative mood, as assessed by the Beck Depression Inventory, and changes in T, FT, or DHEA-S.

Androgens and female sexual function

OBJECTIVES

There is evidence that suggests that androgen might play an important role in different tissues and in modulating sexual response. In women of reproductive age the most important source of androgens present in the blood is the ovary. Androgens complement the contribution of adrenal precursors, which in peripheral organs and target tissue can be transformed into bioactive androgens. The human brain is an important target organ of the sex hormones. The expression in the brain of men and women of estrogenic and/or androgenic receptors (AR) in the cerebral nucleus, especially the hypothalamus, whose important participation in the regulation of the secretion of gonadotrophins, sexual motivation and sexual response is well documented by experimental research on animals and is being verified by studies on functional neuroimaging in humans.

METHODS AND RESULTS

The two pivotal studies that have served for acceptance of the testosterone patch as therapy for hypoactive sexual desire by the European Agency for the Evaluation of Medicinal Products (EMEA) have been The Intimate Study (SM1) and The Intimate Study (SM2). The data on the efficiency of these studies have therefore been clear and positive; the side effects have also been studied and were found in general to be the same as those of the placebo group.

CONCLUSION

There are certain limitations in the studies that are currently being evaluated. Studies with androgens alone and androgens plus estrogens in the natural menopause are ongoing at present.

[Sexuality and pharmacotherapy. Medication-induced disorders of sexual response and pharmacotherapeutic options for the treatment of sexual dysfunctions]

This contribution addresses two different areas of the complex relationship between pharmacotherapy and sexual function and dysfunction in men and women. As many impairments of sexual function are caused by side effects of medications, particularly psychotropic drugs, the first part of the paper describes substances and mechanisms often related to sexual dysfunction with a special focus on antidepressants and neuroleptics. While serotonin reuptake inhibitors entail a high risk of sexual dysfunction, it is often difficult to differentiate the negative impact of the drug from the impairment caused by the mental disorder itself. Ways to deal with these dysfunctions and remedial measures are discussed. In the second section, current pharmacological treatments for female and male sexual dysfunctions are reviewed. While there is no approved pharmacotherapy with established efficacy for female sexual dysfunction with the possible exception of the transdermal testosterone patch for surgically menopausal women, effective pharmacological therapies are available for male erectile disorders. In addition, testosterone substitution is the treatment of choice for hypoactive sexual desire disorders caused by hypogonadism. As sexual dysfunctions are often caused by a mixture of psychological and organic factors, treatment strategies combining pharmacological options and sex therapy are advocated.

Libido as Part of Sexuality in Female Cancer Survivors

PURPOSE/OBJECTIVES

To present the state of knowledge and a suggested program of research related to one part of sexual functioning in female cancer survivors: libido.

DATA SOURCES

Journal articles, monographs, and book chapters.

DATA SYNTHESIS

Sexuality is a broadly defined term with many components. Libido is a component of sexuality and is reviewed with respect to definition, physiology, and measurement. Evidence-based interventions also are discussed.

CONCLUSIONS

Most of the evidence related to enhancing libido involves testosterone, but this has not been tested in cancer survivors. Several clinical questions are yet to be answered regarding physiology as well as nonpharmacologic and pharmacologic interventions for enhancing libido.

IMPLICATIONS FOR NURSING

Nurse researchers could add much to the evidence base on interventions for improving libido and, subsequently, sexual health. Implementing behavioral interventions to enhance libido would be an appropriate nursing function.

Pharmacological effects on sexual function

Many drugs may have effects on sexual function. Sexual function is complex and psychological and relationship issues are likely to have greater impacts on sexual function in women than drugs. Although it is important to understand the effects of drugs on sexual function, physicians should use caution in "medicalization" of sexual function in women [106].

DHEA therapy for women: effect on sexual function and wellbeing

DHEA is increasingly available commercially as a supplement aimed at improving libido and wellbeing in postmenopausal women. However there is scant evidence to support the use of DHEA for this purpose, and safety data for DHEA therapy are lacking. Dehydroepiandrosterone (DHEA) and its sulphate DHEAS are the most abundant circulating sex steroid hormones in women, providing a large precursor reservoir for the intracellular production of androgens and oestrogens in non-reproductive tissues. Levels of DHEA and DHEAS decline with age. It has been proposed that restoring the circulating levels of these steroids to those found in young people may have anti-ageing effects and improve wellbeing and sexual function. However this is not supported by the published literature. We have reviewed the physiology of DHEA and DHEAS in women and the published literature pertaining to the use of DHEA therapy for libido and wellbeing in postmenopausal women. The literature was searched using Medline (Ovid) and Pub-Med for original studies. Overall, the interpretation of data from randomised controlled trials conducted in well women is limited by inadequate sample size and short treatment durations with inconsistent results for the outcomes of libido and wellbeing. Studies of DHEA in women with adrenal insufficiency, although indicating potential improvements in mood and libido, are also limited by their short treatment phase durations. In addition safety data for DHEA therapy are lacking. The potential value of DHEA therapy for women still requires exploration in adequately powered well-designed randomised placebo-controlled trials. The studies of DHEA therapy in women with adrenal insufficiency suggest that this group is the most likely to derive health benefits from DHEA supplementation.

[Level of hormones of pituitary-gonadal axis, penile blood flow and sexual function in men with arterial hypertension during monotherapy with bisoprolol and nebivolol]

Measurement of levels of hormones of the pituitary-gonadal system, dopplerography of penile arteries and questioning after Vasiltchenko were carried out in 30 men (age 35-55 years) with I-II degree arterial hypertension who received monotherapy with bisoprolol and nebivolol for 2 months. Treatment with both superselective beta-adrenoblockers was associated with significant lowering of systolic and diastolic blood pressure and heart rate. Antihypertensive effect of bisoprolol was significantly more pronounced than that of nebivolol. Bisoprolol and nebivolol significantly increased concentration of testosterone (by 82 and 85%, respectively) and prolactin (by 77 and 83%, respectively), lowered levels of estradiol and follicle-stimulating hormone, improved vascular blood flow in penile arteries, and did not worsen sexual function.

Clinical review: Controversies regarding transdermal androgen therapy in postmenopausal women

CONTEXT

Recently, the field of androgen therapy in postmenopausal women has received much attention and press. Although the ovary ceases to produce follicles and estrogen at menopause, it continues to produce androgens. Hence, many oophorectomized women complain of sexual dysfunction (despite adequate estrogenization). Previous studies of nontransdermal testosterone replacement have shown an improvement in libido and sexual frequency, although at the cost of supraphysiological testosterone levels. Transdermal testosterone patch (Intrinsa) was developed to deliver a physiological amount of testosterone. In 2004, the Food and Drug Administration voted not to approve Intrinsa until long-term safety data are available.

EVIDENCE ACQUISITION

Recent trials of Intrinsa in postmenopausal women were included. A MEDLINE search was conducted for articles published over the last 40 yr based on the key words androgen therapy/replacement and postmenopausal women. Relevant placebo-controlled trials of nontransdermal androgen therapy in postmenopausal women were also reviewed.

EVIDENCE SYNTHESIS

Early results from industry-funded trials show that transdermal testosterone therapy results in only moderate (although statistically significant) improvement in libido in surgically menopausal women (on estrogen). However, the published data are of short duration (24 wk). Hence, long-term safety in these women remains unclear.

CONCLUSION

We recommend a short-term trial (not to exceed 24 wk) of transdermal testosterone therapy (once approved) in surgically menopausal (estrogenized) women with distressful sexual dysfunction. Until the patch gets approval, a short trial of oral methyltestosterone in deserving estrogenized women may be justified.