Androgen

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• QCan testosterone cream increase libido?

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  A Dr. Michael Roizen, MD , Internal Medicine, answered

  

  
  
  If you're experiencing a decrease in libido, you may be experiencing a drop in your own androgen levels. Your doctor can prescribe small doses of a testosterone cream or a pill called Estratest, which combines estrogen with libido-increasing testosterone. (Ask your doc to modify this if you are taking an estrogen for hormone replacement therapy.) The cream is applied around the vagina, on the skin, or as drops under the tongue because that's how the large molecules are best absorbed. (If taken orally, the enzymes in the stomach might destroy the hormone before absorption takes place.)

  

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• QWhat are the different types of testosterone therapy?

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  A Dr. Mehmet Oz, MD , Cardiology (Cardiovascular Disease), answered

  Testosterone is a little like chicken: You can get it prepared any way you want. You and your doctor just have to decide which way works best for your health (and your finances). Ideally, you need to work with your doctor to figure out what amount of testosterone will put you in the middle of the normal range, rather than being at the upper or lower end. If you do decide that testosterone therapy is right for you, these are your choices for delivery:

  1. Injections: It's the "wham, bam, was I supposed to pay and thank you, Doc?" method. With weekly, monthly, or even quarterly injections, you get your doses of testosterone immediately. The problem is that they can cause noticeable fluctuations in hormone levels that can affect your mood and your energy.
  2. Sublingually: Here, the testosterone is delivered through a tablet placed under the tongue, typically every twelve hours, which evens out the delivery better than the injection. The downside is that sublingual testosterone has been linked to liver abnormalities.
  3. Through the patch: It's costly, but replacement of testosterone with a patch on your skin—the testosterone is absorbed through the skin to increase the active form of testosterone—is considered safe (though some men have skin reactions to it). It is also a much better match for your body's natural cycles and rhythms. Depending on which you use, the patches can be applied to your abdomen, back, or legs, or (hold the snickers, please) directly onto the scrotum—which seems erotic, but actually works because the key enzyme (DHT), which converts testosterone to its more active form, is in the testes, which are close by.
• QWhat is DHEA?

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  A Dr. Michael Roizen, MD , Internal Medicine, answered

  Though we think of testosterone as the major source of sex drive in men and women, we also need to look at other hormones that influence our overall energy and desires. DHEA is a steroid hormone that's similar to testosterone and estrogen and can actually be converted to these hormones, DHEA (dehydroepiandrosterone) has been considered by many to be the snake oil of medications. It's been marketed as a cure-all that improves just about every system in the body (it started back in the early 1990s, when reports came out that people taking DHEA felt really good).
  
  One big problem: DHEA is considered a food supplement, so it's not regulated tightly by the FDA. Another: Since it's a steroid, it has the same potential long-term side effects as other steroids, such as cancer and a weakened immune system. Just because something makes you feel good doesn't mean it's good for you (think cocaine, heroin, or pints of ice cream).
  
  Nevertheless, I do believe that DHEA can be effective for boosting energy, stamina, and reduced sex drive. So if you are wiped out or have low libido, and you've been checked out by doctors for everything else, maybe— just maybe—low doses of DHEA might help.
  
  You need to talk to your doctor about your own levels and be cautious if you have thyroid issues or a rising PSA, because DHEA is the precursor of androgens, and super high levels of androgens might be linked to prostate cancer; even normal levels may be a problem if you already have the disease.
  
  I don't endorse DHEA as the miracle anti-aging drug that it's often purported to be but, rather, in measured doses as a way to possibly counteract general fatigue and low moods associated with aging, when the usual suspects have been rounded up and no other obvious culprits exist—and then only at the lowest dose that seems to work. My recommendation is to try 25 to 50 milligrams and to monitor if it is working.

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• QWhat are the pros and cons of testosterone supplements?

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  A Dr. Michael Roizen, MD , Internal Medicine, answered

  If your doctor recommends that you boost your testosterone with supplementation, here's what you need to know about its benefits and potential side effects:
  
  In Favor: Besides improvements in the areas most associated with testosterone (libido, muscle mass, bone strength), testosterone therapy has been shown to decrease levels of lousy LDL cholesterol and improve insulin sensitivity, so your chance of suffering diabetes decreases.
  
  Against: The main criticism of testosterone therapy has been its reported links to prostate cancer. While there's evidence that the total size of the prostate enlarges in men who take testosterone, there's no clinical evidence that it actually influences prostate function, such as blocking urinary flow so you are up all night visiting the toilet. And there's no strong data to suggest that testosterone therapy is linked at all to prostate cancer, nor is testosterone in general, as evidenced by the fact that 20-year-old men with the highest testosterone levels are at no more risk for developing prostate cancer later in life than men with normal or low levels.
  
  The other theoretical concern is heart disease, because men develop the disease earlier than women, but no link has been identified when men take supplements with careful monitoring. Long-term testosterone treatment has also been linked to increased baldness, fluid retention, enlarged breasts, and aggravated sleep apnea.
• QCan testosterone help in treating low sexual desire in women?

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  A Boston Women's Health Book Collective , Administration, answered

  Recently, there has been significant interest in the use of testosterone to treat low sexual desire in women. There is some evidence from clinical trials that a postmenopausal woman who takes testosterone experience increased libido.

  A randomized study in 2003 on women who had their ovaries removed and were taking estrogen found that using a testosterone skin patch led to some improvement in sexual desire and activity. But in 2004, a Food and Drug Administration (FDA) advisory committee recommended against approval of a testosterone patch for women because there has not been enough research on the safety of long-term use. Potential safety concerns include increased risk of heart disease and breast cancer.

  The limited research that has been done on the safety of testosterone use by women is not conclusive, but it raises several concerns. More than one study has shown that women who have higher natural levels of testosterone are more likely to get breast cancer; among women who have had breast cancer, those with higher testosterone levels are more likely to experience a recurrence. There is also some research indicating that testosterone use may cause an increase in heart disease. Additional research is needed to explore these potential risks.

• QWhat is AndroGel?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  AndroGel is a prescription testosterone gel. It is prescribed as replacement therapy for men whose bodies make too little of the male hormone testosterone. AndroGel is rubbed onto the skin of the abdomen, shoulders and/or upper arms.

• QWhat should I know about AndroGel before using it?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  AndroGel, which contains the male hormone testosterone, can harm women and children. Young children are at risk of premature development (enlargement of the genitalia, increase libido, aggressive behavior) from direct skin exposure to Androgel. Testosterone could cause body hair changes, acne or other symptoms in women, and it can harm a fetus if a pregnant woman comes in contact with it. Avoid using other medications containing testosterone. Apply only to clean, dry, undamaged skin areas, and use only as directed by your doctor.
  If you use AndroGel, you should be protective of others. Wash your hands after application, and wear a shirt over the parts of the torso where you apply the gel, until you have washed the areas thoroughly.
  AndroGel and other testosterone products have been linked to blood clots, called deep vein thrombosis. If you experience pain, swelling, warmth or redness in your leg, or if you have shortness of breath, get medical help right away.