Wow! A Drug for Sex Once More a Month? Sign Me Up!

I don’t care if it may give me breast cancer or heart disease. Thanks, APHRODITE Study Team!!

APHRODITE Study Team? ROTFL!!

I SWEAR TO GOD I am not making up this goofy study name.

I wonder if the study investigators ever got horny at one of their research meetings? Or by looking at their data?

Anyway, seriously folks. The results of the “A Phase III Research Study of Female Sexual Dysfunction in Women on Testosterone Patch without Estrogen (APHRODITE)” study published in the NEJM today showed that if post-menopausal women who have a loss of libido put a testosterone patch on their arms that they will have satisfying sex once a month more than they are currently having, although there may be a risk of breast cancer or cardiovascular disease [read on]

I’ve got a tip for the marketers of this testosterone patch. If the women are having satisfying sex only once a month, and now they have it twice, why don’t you say that the drug results in a 100% increase in satisfying sex!!!

Ha ha ha ha ha!

OK folks all fun aside lets look at the data. In this study Davis et al (Davis SR et al NEJM 2008; 359(19): 2005-2017. November 6 2008) studied 814 women treated for 52 weeks with 300 or 150 microgram testosterone patches or placebo patches. There was an increase in “satisfying sexual episodes” of 2.1 in treated versus 0.7 for placebo, an increase that was statistically significant. There was about a 10% difference in scores on a sexual pleasure scale. 30% grew unwanted hair v 23% for placebo. Breast cancer was diagnosed in 4 out of 527 treated women and in none of the women on placebo.

That’s right folks, sex once a month. And possible risk of getting breast cancer.

And a beard.

Nonconclusive results about cancer you say. And Mrs Robinson asks if she has anything to worry about.

Well a recent study by Tamimi et al (J Natl Cancer Inst 2007; 99(15): 1178-1187) found that women who naturally had the highest testosterone levels (top 25%) had a two fold increase in breast cancer compared to women in the lowest 25%.

And another study by Maturana et al (Metabolism, 2008; 567 (7):961-965) found that postmenopausal women with elevated testosterone had increases in markers of inflammation and endothelial dysfunction, C-reactive protein (CRP) and endothelin, that have been associated with increased risk of atherosclerosis.

And let’s not forget the increased risk of heart disease and cancer associated with hormone replacement therapy (HRT) which I have written about before, and testosterone has to have a suspicion of similar risk.

The authors of the current study point to the fact that about a third of post-menopausal women have sexual dysfunction, and imply that even the meager gain they eak out with their patch is worth it in terms of keeping their mans happy. However they need to provide evidence for their implied claim that libido is killed by menopause and that women need to use a hormonal patch for that. They seem to hark back to the physician author of Feminine Forever, who implied that menopause was a disease to be treated with HRT, and that women became old crones, wrinkled and ugly, nasty, and incapable of sex, and that they needed HRT to treat this malady. Well I won’t belabor that now, and you can follow the links on this web site if you want to learn more about HRT, but I can tell you that controlled studies show it has no effect on libido, and only increases risk of cancer and heart disease. So there.

The authors imply that menopause is associated with an inevitable decline in libido for women, and that they need to take a drug to correct that. But I am not aware of any literature to support this conclusion, and if anyone has something, let me know. I mean, Mrs. Bremner seems to be doing OK so far.

As far as I know these testosterone patches are approved for hypogonadism in men with low testosterone, but are widely used off label for loss of libido in men and women. The APHRODITE study results may be used to promote off label use of the patches. Stay tuned.

The FDA posted some slides on this topic here.

Thanks to Marilyn Mann for sending me articles and comments on this topic.

[originally posted on November 6, 2008]

Therapy Patient wrote on November 12, 2008

What always bothers me about many studies (such as this one) is that they don’t seem test moderate treatments. Why would women be treated with JUST testosterone? That is not a treatment designed to bring a woman back to her former natural state. My female gynecologist, a UC San Francisco Medical Center clinical faculty member, Dr. Rikki Pollycove, recommends very low dosage hormone replacement. I am on Divigel (estradiol gel) 0.5mg which keeps me just barely out of the range of having hot flashes plus 25 mg. per day of DHEA (dehydroepiandrosterine) which I understand is a testosterone replacement. The DHEA DID increase my libido, but it wasn’t absent before I took it. However, the DHEA makes me think about sex in a way I had not done in a number of years (age 57 female). I’d be ready once or twice a day for sex if I had a ready partner. I found HRT difficult to adjust to due to side effects which for me are swollen, painful breasts, plus occasional hot flashes (which I do NOT have off HRT). On the positive side I think I have younger looking skin than my peers, and my vaginal tissue is moist and pliant rather than dried, and I have more sexual interest and ability. I am hoping it helps put off cognitive decline of aging, also.