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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. 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

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  1. 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

  2. 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

  3. 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.

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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.

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