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.

Testosterone Treatments Linked To Heart Risks

USA Today reports on a recent study published in the Journal of the American Medical Association.
November 6, 2013

Testosterone treatments may increase risks for heart attacks, stokes and death in older men with low hormone levels and other health problem, a big Veterans Affairs study suggests.

The results raise concerns about the widely used testosterone gels, patches, or injections that are heavily marketed for low sex drive, fatigue and purported anti-aging benefits, the authors and other doctors said.

Men who used testosterone were 30 percent more likely to have a heart attack or stroke or to die during a three-year period than men with low hormone levels who didn’t take the supplements. Hormone users and nonusers were in their early 60s on average, and most had other health problems including high blood pressure, unhealthy cholesterol and diabetes.

MY TAKE:
This is not the first study to show increased risk from using testosterone as HRT (hormone replacement therapy). It’s making big news because of the dramatic increase in prescriptions for testosterone in the past few years. Over 5 million men used testosterone in the US with sales totaling 1.6 billion dollars in 2011. Just look at the recent television ads and you know those numbers are much higher today.

More than 50% of men over the age of 45 suffer some form of sexual dysfunction. This is really a statement about our declining health as a nation and the generally accepted idea that we can just cover up some of the symptoms with drugs (in this case hormones) and the problem will go away. As men age, testosterone production shifts from the testicles to the adrenals. However, many men do not have the good general health to make the transition. Long term adrenal stress, poor liver function, and subclinical hypothyroidism are behind this and many of our chronic, degenerative diseases. Metabolic syndrome is the name given to the list of predisposing factors that ultimately lead to diabetes, heart disease, and death.

Several herbs are commonly used to support healthy adrenal function. Clinical studies have showed marked improvement in both testosterone and sexual function with the use of Tribulus, Korean Ginseng, Ashwaganda, and Rehmannia. The South American herb Maca also shows great promise, but needs more research. These herbs are all adaptogens, not only supporting repair and regeneration of the adrenal glands, they also repair DNA as shown by DNA fragmentation studies on human sperm.

THE BOTTOM LINE:
If you suffer from low testosterone levels, have an evaluation with a qualified nutritionist. First address your general health. It’s quite possible that improving your health will resolve the hormone deficiency.