Testosterone therapy in women with androgen deficiency: Its time has come.

The concept that women may have a testosterone deficiency is controversial, as is the possibility of testosterone replacement therapy for women. It has been stated that androgen deficiency is a new concept; however, women have been treated off-label for more than 50 years. A number of objections to such therapy in women have been reviewed and discussed, including the lack of a normal age-related concentration range for androgens, the lack of randomized, placebo-controlled clinical trials, and the possibility of chronic adverse effects, particularly the risk of cardiovascular disease and breast cancer.

Hypogonadism in men with erectile dysfunction may be related to a host of chronic illnesses.

The prevalence of hypogonadism has been found to be increased in certain chronic illnesses, especially diabetes, hypertension and obesity. Recently, the prevalence of hypogonadism in primary care practices mirrored that in our population of men with erectile dysfunction (ED). In this study, the prevalence of hypogonadism in nearly 1000 men with ED was tabulated, using a retrospective chart review, and analyzed for association with the various contributing medical and psychological factors.

The relationship between testosterone levels, the metabolic syndrome (by two criteria), and insulin resistance in a population of men with organic erectile dysfunction.

Introduction: Erectile dysfunction (ED) in men increases with age, as does cardiovascular disease (CVD). Major risk factors of CVD are similar to ED, including insulin resistance (IR) and metabolic syndrome (MS). Hypogonadism has been associated with MS and IR in general populations.

ED2: erectile dysfunction = endothelial dysfunction.

Erectile dysfunction (ED) is a common condition in men, and increases with age. Cardiovascular disease (CVD) is the leading cause of death in men and also increases in prevalence with advancing years. The common link between the two conditions is endothelial dysfunction that leads to vascular insufficiency of the coronary and penile arteries.

Testosterone and erectile physiology.

The role of testosterone deficiency in sexual dysfunction is an important aspect of aging, because it affects such a large proportion of men over 50 years old. A number of age-related factors can cause sexual dysfunction (in particular erectile dysfunction) and testosterone deficiency, such as chronic illness and multiple medications, and the causative link between hypogonadism and erectile dysfunction is still debated. However, studies in castrated animals have proven that addition of testosterone, and its conversion to dihydrotestosterone, can restore erectile function.

Dehydroepiandrosterone therapy as female androgen replacement.

Dehydroepiandrosterone (DHEA) is an abundant circulating androgen precursor preferentially produced by the adrenal glands. DHEA has been shown to exert its effects via downstream conversion to sex steroid hormones, neuromodulation, improvement in endothelial cell function, and possibly by acting on a cell membrane-bound receptor. Low levels of circulating DHEA have been demonstrated in women with diminished libido and other symptoms of sexual dysfunction.

Characterization of patients in a medical endocrine-based center for male sexual dysfunction.

Objective: To characterize the patient population in a multidisciplinary sexual dysfunction clinic whose focal person is an endocrinologist and to summarize the initial manifestations, the demographics of the study group, and their associated medical conditions.

Methods: We undertook a retrospective analysis of the medical records of all new consultations in a center for sexual function during a recent 2-year period.

Results: During the period from July 1995 to July 1997, 1,050 men were seen in new consultations for sexual dysfunction at our medical facility, and complete medical records could be retrieved for 990 of them.

Improvement in erectile function in men with organic erectile dysfunction by correction of elevated cholesterol levels: a clinical observation.

Purpose: We determined that use of a statin drug to lower cholesterol would improve erectile function in men who have hypercholesterolemia as the only risk factor for erectile dysfunction (ED).

Materials And Methods: A total of 18 men were determined to have increased cholesterol as the only risk factor for ED by history, system review, physical examination and laboratory analysis. Nine of these men agreed to participate in the study.

Serum androgen levels in healthy premenopausal women with and without sexual dysfunction: Part A. Serum androgen levels in women aged 20-49 years with no complaints of sexual dysfunction.

Androgen insufficiency is a recognized cause of sexual dysfunction in men and women. Age-related decrements in adrenal and gonadal androgen levels also occur naturally in both sexes. At present, it is unclear if a woman's low serum androgen level is a reflection of the expected normal age-related decline or indicative of an underlying androgen-deficient state.

Serum androgen levels in healthy premenopausal women with and without sexual dysfunction: Part B: Reduced serum androgen levels in healthy premenopausal women with complaints of sexual dysfunction.

Androgen insufficiency has been associated with decreased libido and arousal in postmenopausal women, but rarely has been evaluated in healthy premenopausal women. In all, 32 healthy premenopausal women were enrolled in this study, 18 with one or more complaints of sexual dysfunction and 14 without. Assays of ovarian and adrenal androgens were measured before and after ACTH stimulation.

Prevalence of cardiovascular risk factors in erectile dysfunction.

Objective: Thirty million men in the United States may have erectile dysfunction, and coronary artery disease (CAD) is the major cause of death in men over 55 years old. Several studies have shown a correlation between erectile dysfunction and risk factors for coronary artery disease. Hyperlipidemia plays a pivotal role in CAD, and obesity is now considered an independent risk factor for CAD.

Testosterone insufficiency in women: fact or fiction?

Androgen deficiency in women is a valid diagnosis in premenopausal, as well as in postmenopausal women, under certain conditions. This diagnosis is hampered by a lack of precise definitions and sensitive assays for testosterone. Precise normal ranges for control populations are lacking, and thus many studies have used pharmacological instead of physiological levels of testosterone in treatment protocols.

Screening for androgen deficiency in women: methodological and interpretive issues.

Objective: To appreciate the problems in obtaining and interpreting androgen levels in women.

Design: Review of the literature to compare various laboratories and methods of analysis of serum androgens.

Patient(s): Normal control populations culled from the literature to compare with patients previously reported on by us; data from our laboratory quality control compared with data from the literature.

Decreased free testosterone and dehydroepiandrosterone-sulfate (DHEA-S) levels in women with decreased libido.

A prior study has shown that premenopausal women could have decreased testosterone levels and still have regular menstrual cycles (Guay, 2001). Since ovarian function in such women was normal, the question of a possible adrenal dysfunction causing androgen deficiency was considered. If this was true, the question then arose as to whether the same defect could be seen in postmenopausal women.

Yohimbine treatment of organic erectile dysfunction in a dose-escalation trial.

Yohimbine has had questionable effects in men with organic erectile dysfunction. We conducted this study to better define the population of men responsive to yohimbine, because tobacco was thought to affect a regimen of yohimbine more than other risk factors. We measured nocturnal penile tumescence with the RigiScan monitor, hormone profiles, answers to the Florida Sexual Health Questionnaire, and clinical responses at baseline and after two different doses of yohimbine in 18 nonsmoking men with erectile dysfunction.

Sexual dysfunction in the diabetic patient.

The incidence of diabetes mellitus is increasing at an alarming rate, and diabetic men already make up a quarter of the men in our own specific medically-oriented population of erectile dysfunction. The incidence of sexual dysfunction in men with diabetes approaches 50%, and this is only slightly lower in diabetic women. Hypertension is a frequent risk co-factor, being seen between 40% and 60% of diabetics in the literature.

Decreased testosterone in regularly menstruating women with decreased libido: a clinical observation.

Much more information is available concerning decreased libido in postmenopausal than in premenopausal women. Even less is known about androgen deficiency in younger women. We measured total and free testosterone levels in 12 consecutive premenopausal women complaining of decreased libido.

Testosterone treatment in hypogonadal men: prostate-specific antigen level and risk of prostate cancer.

Objective: To assess prostate-specific antigen (PSA) levels in hypogonadal men after testosterone replacement by three different methods and attempt to determine any possible relationship between hypogonadism and prostate cancer in this study population.

Methods: A total of 90 consecutive men who had erectile dysfunction and were found to have hypogonadism were monitored with digital rectal examination (DRE) and measurement of PSA levels before and after testosterone replacement therapy. The patients were treated with one of three options: (1) testosterone enanthate by intramuscular injections, 200 or 300 mg every 2 or 3 weeks (N = 25); (2) testosterone nonscrotal patches, 5 mg daily (N = 16); or (3) clomiphene citrate, 50 mg orally three times a week, in patients with functional secondary hypogonadism (N = 49).

Clinical experience with intraurethral alprostadil (MUSE) in the treatment of men with erectile dysfunction. A retrospective study. Medicated urethral system for erection.

Objective: The Food and Drug Administration (USA) approved the transurethral administration of prostaglandin (alprostadil in January 1997), which had an efficacy of approximately 50% in clinical trials. We studied its effectiveness in clinical practice.

Methods: Patient and partner education was followed by an initial office trial of a medicated urethral system for erection (MUSE) after other medical risk factors were corrected during a 2- to 4-month period.