Friday, October 24, 2014

Practice Guideline Nixes Testosterone Therapy for Women

New clinical practice guidelines issued by the Endocrine Society were published in the October issue of the Journal of Clinical Endocrinology and Metabolism.

The guideline is an update from 2006. “We don’t have any data to support the use of testosterone or DHEA (dehydroepiandrosterone) in women, and there’s no evidence for an androgen-deficiency syndrome,” says Margaret E. Wierman, MD, from the University of Colorado. She is the writing chair and Endocrine Society vice president.

Specifically, testosterone is not recommended to treat women with infertility or cognitive, cardiovascular, metabolic, or sexual dysfunction (other than hypoactive sexual desire) or to promote bone health or well-being, she added.

Limited evidence suggests that postmenopausal women who are upset by and diagnosed with hypoactive sexual desire disorder might benefit from a 3-to-6 month trial dose of testosterone, according to the guideline. But these patients would have to be closely monitored for signs of androgen excess.

Moreover, “the next bump in the road…is that currently, there are no FDA-approved preparations [of testosterone for women] in the US,” and the testosterone patch for women is no longer approved in Europe, Dr. Wierman explained.

However, some physicians still opt to prescribe testosterone therapy to otherwise-healthy women on an off-label basis, she noted. “If you’re going to use it off label – which we don’t recommend - you really have to carefully monitor [testosterone levels]…so that you’re not overshooting the normal range,” she stressed.

The few studies that have looked at giving DHEA, a precursor of testosterone, to women with low levels of testosterone have not shown any benefit either, she noted.

Meanwhile, the definition of hypoactive sexual desire disorder has changed, Dr. Wierman observed. “The new definition says it has to be distressing to the person, which makes sense.”

Further research and ongoing improvements in androgen assays are needed to clarify the role of testosterone in women, the authors conclude.

The adrenal glands manufacture DHEA. In women, this is their sole source of testosterone. DHEA can also be converted into progesterone or any of the estrogens. After menopause the adrenals are responsible for producing all these various sex hormones.

Cortisol, the stress hormone competes with DHEA production in the adrenals. Under high levels or long term stress, cortisol production increases and DHEA production is reduced. This creates much of the hormone imbalance seen during menopause.

Using either DHEA or testosterone is hormone replacement therapy (HRT). While testosterone is only available (legally) by prescription, DHEA can be purchased at any health food store. Although the human body should produce about 25mg of DHEA daily, supplements can contain as much as 50mg per tablet.

I frequently test for DHEA deficiency, but a rarely recommend supplementation. When needed I will recommend a 5mg dose per day for 1 week only. In the past five years, I have done so only four times.

HRT, including DHEA and testosterone, can provide symptomatic relief. However, it suppresses hormone production by the body. I believe HRT should be used as short term therapy only when absolutely necessary, to be replaced by long term nutritional support.

Testosterone is very potent and the female body needs very little. I have only treated a couple of cases of androgen excess. In one of the cases, a woman had developed male characteristics, absorbing the testosterone from her husband’s topical prescription through bed linens.

HRT with either testosterone or DHEA is potent therapy with potential serious side effects. I much prefer botanicals like tribulus, ashwaganda, Korean ginseng, and maca. If you are considering HRT, please give herbal medicine a try.

Source: Medscape -October 7, 2014

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