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Androgen Therapy for Low Sexual Desire: A Concerned Physician’s View. James A. Simon, M.D. Clinical Professor George Washington University Washington, DC Medical Director The Women’s Health Research Center Laurel, MD. Issues. Is low sexual desire really a clinical problem for women?

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androgen therapy for low sexual desire a concerned physician s view

Androgen Therapy for Low Sexual Desire: A Concerned Physician’s View

James A. Simon, M.D.

Clinical Professor

George Washington University

Washington, DC

Medical Director

The Women’s Health Research Center

Laurel, MD

issues
Issues
  • Is low sexual desire really a clinical problem for women?
  • Beyond clinical concerns about acne, and hirsutism, does androgen therapy increase a woman’s risk of breast cancer?
  • Personal Perspective
prevalence of sexual dysfunction in women
Prevalenceof Sexual Dysfunction in Women

43% of Women Experience Some Form of Sexual Dysfunction

32%

28%

27%

Percentage of Women*

21%

*Women aged 18-59 years

Laumann EO, et al. JAMA. 1999;281:537-544.

slide4
Sexual Behavior and Sexual Dysfunctions After Age 40:The Global Study of Sexual Attitudes and Behaviors
  • Objective: To assess the importance and prevalence of sexual dysfunction among middle aged and older adults around the world
  • Data were collected in 29 countries from 27,500 men and women aged 40-80 using questionnaires
  • Sexual dysfunction was defined as “frequent and persistent problems

Sexual dysfunctions studied in women were:

    • Lack of sexual interest
    • Lubrication difficulties and pain during intercourse
    • Inability to achieve orgasm

From: Nicolosi, Laumann, Glasser, et al. Urology 64: 991-997, 2004

slide5
Sexual Behavior and Sexual Dysfunctions After Age 40:The Global Study of Sexual Attitudes and Behaviors
  • Results (women):

65% of the women had sexual intercourse during the past year

  • The most common sexual dysfunctions found in women were:
    • Lack of sexual interest (21%)
    • Lubrication difficulties and pain during intercourse (16%)
    • Inability to achieve orgasm (16%)
  • Conclusion: Overall 39% of the women said they were affected by at least one sexual dysfunction

From: Nicolosi, Laumann, Glasser, et al. Urology 64: 991-997, 2004

slide6
Breast Cancer Incidence in Postmenopausal Women Using Testosterone in Addition to Usual Hormone Therapy
  • Objective: To determine if testosterone protects women from breast cancer when added to standard hormone therapy
  • Design: Retrospective, observational trial of 508 postmenopausal women receiving testosterone therapy (average age 56.4; mean follow-up 5.8 years)
  • Outcomes: Breast cancer incidence with testosterone compared to nonusers and standard hormone therapy users from the literature

From: Dimitrakakis, Jones, Liu and Bondy. Menopause: 11: 531-535, 2004

slide7
Breast Cancer Incidence in Postmenopausal Women Using Testosterone in Addition to Usual Hormone Therapy
  • Results: expressed as rate/100,000 women-years
    • On testosterone: 238
    • On testosterone, estrogen/progestin: 293
    • On estrogen/progestin (from WHI): 380
    • On estrogen/progestin (from Million Women Study): 521
    • Never users (from Million Women Study): 283
  • Conclusions: “…the addition of testosterone to conventional hormone therapy for postmenopausal women does not increase and may indeed reduce the hormone therapy-associated breast cancer risk-thereby returning the incidence to the normal rates observed in the general, untreated population”

From: Dimitrakakis, Jones, Liu and Bondy. Menopause: 11: 531-535, 2004

summary and conclusions
Summary and Conclusions
  • There is a serious need for safe and effective therapies for all aspects of sexual dysfunction in women
  • Low sexual desire is a very common complaint of postmenopausal women affecting more than 20% of women over age 40
  • While hormone therapy appears to increase the risk of breast cancer, the addition of testosterone does not appear to increase this risk.