Androgen Therapy for Low Sexual Desire: A Concerned Physician’s View James A. Simon, M.D. Clinical Professor George Washington University Washington, DC.

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Presentation transcript:

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? Beyond clinical concerns about acne, and hirsutism, does androgen therapy increase a woman’s risk of breast cancer? Personal Perspective

Prevalence of Sexual Dysfunction in Women Laumann EO, et al. JAMA. 1999;281: *Women aged years 32% 28% 21% 27% Percentage of Women* 43% of Women Experience Some Form of Sexual Dysfunction

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 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: , 2004

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: , 2004

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: , 2004

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: , 2004

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.