Re: Testerone for decreased libido
From: art fougner, md (evsono@pipeline.com)
Sun Mar 4 16:14:38 2001
those so-called "pure scientists" are often not so pure and not terribly
scientific. remember, mathematics, the purest of sciences, is based on
assumptions.
art
At Sun, 4 Mar 2001, Efrain Ramirez wrote:
>
>"There are no facts, only interpretations."
>
>J Womens Health Gend Based Med 2000;9 Suppl 1:S9-13 (ISSN: 1524-6094)
> De Cherney AH
>Department of Obstetrics and Gynecology, University of California, Los
>Angeles School of Medicine, 90055,
> USA.
>There is only inferential evidence based on observational studies and
>deductive reasoning that allows us to
>suppose there are hormone receptors in the human brain that are
>associated with libido. Data indicate that
>sexually active pubescent women have higher testosterone levels than
>matched controls. However, any
>number of nonhormonal events in puberty could be related to these
>changes. Another circuitous way to
>look at hormone libido receptors in the brain is by evaluating patients
>on birth control pills, in whom sexual
>activity paradoxically decreases. Sex hormone-binding globulin (SHBG)
>levels are increased, and,
>therefore, free testosterone levels seem to be affected by the use of
>birth control pills. In addition, the
>progestins in the pill are 19-nortestosterone derivatives, which may
>have some androgenic effect in their
>own right. Women on estrogen replacement therapy with the addition of
>testosterone seem to report
>increased libido, and there is subjective information that there is an
>increase in psychological sense of
>well-being. It has been well documented that females with adrenogenital
>syndrome are masculinized in
>utero, indicating imprinting on behavior. Because of the nature of the
>end point (e.g., increased libido), it is
>difficult to draw concrete conclusions on the presence of libido
>receptors in the human brain. Because the
>outcomes and end points are so soft, it is difficult to come to a
>consensus, and in fact this topic polarizes
>opinions of the pure scientist (objective) against the clinician
>(subjective). At Sun, 04 Mar 2001, Mark Perloe wrote:
>>
>>>Because of the absence of convincing evidence of significant and direct
>>>net benefit on a long term basis, I rarely prescribe an androgenic
>>>agent.
>>
>>Zach,
>>
>>I agree with your decision not to prescribe androgens. I am foften referred
>>menopausal patients who have failed HRT and find androgens levels well in
>>excess of normal premenopausal levels. This is often accompanied by an
>>adverse shift in lipid profiles as well. Interestingly, women with PCOS
>>usually have elevated androgens levels and if they behaved like
>>testosterone-treated rats, should be trying to seduce furniture. This is
>>definitely not the case. These hyperandrogenic women usually find decreased
>>libido a prominent component of their PCOS symptomatology. My take is that
>>an abrupt cessation of ovarian androgen production following bilateral
>>oophorectomy may explain some cases of decreased libido. Other
>>endocrinologic conditions I have seen in women with decreased libido are
>>hyperprolactinemia and hypothyroidism. But, I don't think we can call upon
>>evidence based medicine to treat these women. This brings me to another
>>concern.
>>
>>While evidence based medicine (EBM) has allowed us to abandon many
>>ineffective treatment regimens, unfortunately it has been used to refuse
>>coverage for many treatments that have not yet undergone EBM validation. We
>>must be careful not to fall into the trap that equates a lack of evidence
>>(EBM double blind randomized clinical trial) with lack of clinical benefit.
>>If we remove clinical judgement from the picture and reduce medicine to
>>merely allocating patients to the appropriate EBM clinical pathway, we will
>>be become medical technicians and provides and not healers.
>>
>>--
>>Mark Perloe, M.D. http://grs.ivf.com 404-843-2229
>>5445 Meridian Mark Rd, Suite 270, Atlanta, GA 30342
>>
>--
>"Life is neither the notes nor the silence between the notes, but the music that
> arises out of sound and silence felt as a living whole. Stop choosing...between
> chaos and order, and live at the boundary between them, where rest and action
> move together..." David Whyte
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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