Long-term data for safety and benefit of testosterone therapy in women are lacking, but such data are required before long-term practice of testosterone can be recommended. Similarly, safety data for the apply of testosterone in nonestrogen replaced postmenopausal women are lacking and no recommendation for its practice can be made currently. Nor can the supplementation of T to premenopausal women be urged until such time there exist safety and efficacy data. Unluckily, any enduring benefit after short-term treatment, although theoretically feasible, is unproven. In addition, supplementing T on a temporary basis only, could have unfavorable effects on the couple if an improvement associated with T therapy is no longer apparent when it is withdrawn.
If despite the above, T supplementation is contemplated, careful assessment must render absence of ongoing psychological (interpersonal, intrapersonal, contextual, and societal) or physical factors negatively affecting sexual interest and arousability. On the basis of available data, no specific testosterone regime or dose can yet be advocated. The chosen formulation of testosterone must have pharmacokinetic data pointing that it produces blood levels within the normal premenopausal range. Achieving physiological free testosterone levels by transdermal delivery appears to be the best approach.
Contraindications to testosterone therapy include androgenic alopecia, seborrhea, or acne, hirsutism as well as a history of polycystic ovary syndrome, and estrogen depletion. Oral methyl testosterone therapy is contraindicated in women with hyperlipidemia or liver dysfunction. Regular follow up is both clinical inspection of skin and hair for seborrhea, acne, hirsutism, and alopecia and biochemical through monitoring of free/bioavailable testosterone and SHBG, keeping these values within the normal range for premenopausal women. Of note, methyl-T is not included in the usual assays for T. Possibly, the target level for older women should be even lower but this remains obscure. Lipid profile and glucose tolerance are also monitored. The current recommendation is to prescribe only for 12 months owing to lack of long-term safety data.
Tibolone
Tibolone is a synthetic steroid with tissue selective estrogenic, progestogenic, and androgenic actions. In usage in Europe for more than 10 years, tibolone allows some relief from vasomotor symptoms, estrogen agonist activity on the vagina and bone, but not on the endometrium. Tibilone was thought not to have estrogen agonist activity on breast tissue; but a recent, albeit nonrandomized but very profound study of postmenopausal hormonal therapy showed a similar increase in breast cancer in women receiving tibolone and those receiving various combinations of estrogen and progestins. The average (presumed beneficial) estrogenic outcomes on lipids are not seen, but it is of note that tibolone does not promote (unwanted) coagulation. Prospective randomized trials comparing tibolone to placebo or to various formulations of estrogen and progestin therapy have been done. Although in most but not all, there was significant improvement in sexual interest in the women receiving tibolone; no study focused on sexually dysfunctional women. Recruitment centered on vasomotor symptoms or bone density. Studies in postmenopausal women with loss of arousability and therefore of sexual desire are needed.
Author Resource:-
David Crawford is the CEO and owner of a vigrx plus company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of premature ejculation This article may be freely distributed if this resource box stays attached.
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