High doses of testosterone significantly improve sexual function among women who have had their uterus and ovaries surgically removed, a clinical study demonstrates. The results were presented at The Endocrine Society's 95th Annual Meeting in San Francisco. Surgical removal of the uterus, or hysterectomy, and the ovaries, which is called oophorectomy, is performed to treat various diseases, including cancer. Hysterectomy is also performed as an elective sterilization, usually among older women, and may be combined with oophorectomy if ovarian disease is present. In cases of a family history of ovarian cancer, an oophorectomy of healthy ovaries may be performed in conjunction with hysterectomy to prevent future disease. Since the ovaries produce the hormones estrogen and progesterone, which help regulate the menstrual cycle, their removal causes a drop in these hormones. A side effect of this sudden hormonal drop is a decreased interest in sexual activity, which can disrupt intimate relationships and affect quality of life. There has been emerging interest in supplemental hormonal treatment with the primary male sex hormone, testosterone for disrupted sexual functioning in postmenopausal women. To determine whether testosterone therapy increases sexual functioning among patients who have had hysterectomy and oophorectomy, study investigators recruited 71 women who had undergone these procedures. For the first 12 weeks of the study, participants received estrogen replacement. Investigators then randomly assigned them to one of five groups for weekly injections of placebo, or 3, 6.25, 12.5, or 25 milligrams (mg) of an intramuscular testosterone medication, called testosterone enanthate, for 24 weeks. They found that sexual functioning significantly improved among the group of women who received 25 mg of testosterone compared to placebo. In addition, the weekly number of sexual encounters among this group increased by 2.7 encounters. These improvements were related to greater blood concentrations of free testosterone, which means that the hormone is more active because it is not bound to proteins in the blood. The groups receiving lower doses of the hormone, however, did not have improvement in sexual functioning. "This study provides novel information about the range of testosterone doses associated with potential beneficial effects on sexual function in women," said the study's lead author Grace Huang, M.D., endocrinology fellow at Boston University Medical Center. "However, long-term studies are needed to determine whether these improvements in sexual function can be achieved safely without increasing risk for heart disease." A primary concern with testosterone replacement therapy is that it can cause symptoms of masculinization among women. These symptoms include unwanted hair growth, lower voice tone, and increased muscle mass. Few of these side effects were reported in this study. Investigators used hormonal tests to measure blood concentrations of both total and free testosterone. To assess sexual function, they used a standard questionnaire for women. Participants also completed weekly logs to document sexual activity.
Postmenopausal women had better improvement in verbal learning and memory after receiving treatment with testosterone gel, compared with women who received sham treatment with a placebo, a new study found. Results were presented at The Endocrine Society's 95th Annual Meeting in San Francisco.
"This is the first large, placebo-controlled study of the effects of testosterone on mental skills in postmenopausal women who are not on estrogen therapy," said principal investigator Susan Davis, MBBS (MD), PhD, of Monash University, Melbourne, Australia. "Our study has confirmed our similar findings from two smaller studies in postmenopausal women and suggests that testosterone therapy may protect women against cognitive decline after menopause."
Menopause has been linked with memory decline because of a decrease in levels of the protective hormone estrogen. Yet testosterone also is an important hormone in women because it has a role in sexual desire, bone density and energy while improving mood. In men, studies have shown that testosterone replacement has favorable effects on brain function.
In this new, investigator-initiated study, the Australian researchers randomly assigned 92 healthy postmenopausal women, ages 55 to 65, who were not receiving estrogen therapy, to receive one of two treatments for 26 weeks. The treatments were a testosterone gel (LibiGel, BioSante Pharmaceuticals) applied daily to the upper arm, or a placebo, an identical-appearing gel containing none of the medication. Neither the study participants nor the investigators were aware of which gel the women received.
Before treatment and at 12 and 26 weeks of treatment, subjects underwent comprehensive testing of their cognitive function (mental skills) using a computer-based battery of tests designed for people with normal brain function (CogState). Ninety women completed the study. The investigators found no cognitive differences between groups before the start of treatment.
After 26 weeks, the women who received testosterone therapy had a statistically significant and clinically meaningful improvement in verbal learning and memory - how well they recalled words from a list, Davis reported. The average test score for the testosterone-treated group was 1.6 points greater than that of the placebo group. No differences between the groups were evident for any other cognitive test.
Women receiving testosterone therapy reported no major side effects related to the gel. Their testosterone levels increased with treatment but remained in the normal female range.
Although further study is needed in more women, Davis said the results are important. "There is no effective treatment to date to prevent memory decline in women, who are higher risk of dementia than men," she said. www.vivenaturalhormones.com
Estrogen replacement therapy is associated with a significant decrease in anxietysymptoms among girls with anorexianervosa, a new clinical trial finds. The results were presented today at The Endocrine Society's Annual Meeting in San Francisco.
"This is the first study to show that estrogen replacement ameliorates the tendency for anxiety in anorexia nervosa and may prevent increasing body dissatisfaction with weight gain," said the study's lead author Madhusmita Misra, MD, MPH, pediatric endocrinologist and associate professor of pediatrics at the Massachusetts General Hospital and Harvard Medical School in Boston, MA. "This is very important given that anorexia nervosa can be difficult to treat, and underlying anxiety, eating attitudes and concerns of body shape with increasing weight during treatment may reduce the success of treatment programs."
Anorexia nervosa is a severe eating disorder that primarily affects teenage girls, although boys, as well as older and younger people, can also develop it. Approximately 0.2-1 percent of teenage girls suffer from the disorder.
The disorder is characterized by a distorted body image, which causes patients to view themselves as heavy, or fat, even when their body-mass index is well below the normal range. As the disease progresses, patients become increasingly preoccupied with weight loss through restricting food and/or increasing activity with intense, frequent exercising. Some resort to purging behaviors to rid themselves of any food that they consume.
Complications include depression, increased risk of suicide and weakened bones, which increase the risk of fractures and osteoporosis. Among girls, menstrual periods stop occurring as body weight and estrogen production drop. If left untreated, the disorder can cause death. Unfortunately, anorexia can be quite difficult to treat, and relapse is common.
In this study, investigators found that anxiety scores on a standardized questionnaire decreased as estrogen levels increased. This relationship was unaffected by weight gain. Additionally, if weight gain did occur, estrogen replacement appeared to prevent a worsening of attitudes toward body image and food, as assessed using the Eating Disorders Inventory-II questionnaire.
"Identification of therapies that reduce the tendency to experience anxiety and reduce body dissatisfaction with weight gain may have a major impact in reducing relapse," Misra said. "These findings have the potential to impact therapy in anorexia nervosa with early implementation of estrogen replacement in girls who are estrogen deficient."
Participants included 72 teenage girls diagnosed with anorexia nervosa. At the start of the study, all were between 13 and 18 years old, and had a measured bone age of at least 15 years.
Investigators randomly assigned participants to receive estrogen or placebo for 18 months. Of the 72 initial participants, 38 received estrogen and 34 received placebo. At the study's start and end, participants completed questionnaires designed to assess anxiety, and attitudes toward eating and body image. Thirty-seven participants completed the study, with 20 receiving estrogen and 17 receiving placebo. www.vivenaturalhormones.com
