Testosterone levels and diabetes

Dr Lichten discusses the link between testosterone and diabetes. By replacing testosterone in diabetic men insulin requirement can be reduced by 50%.

Study results aren't definitive, but emotional issues require attention

Study results aren't definitive, but emotional issues require attention
by Theresa Tamkins


If you're a fan of Desperate Housewives or Sex and the City, this may come as a bit of a shock: A large chunk of women in their 30s and 40s aren't obsessed with finding a hot new lover; they're worried about a lack of interest in sex with their current partner—or anyone else, for that matter.

As many as one in four women of any age report sexual dissatisfaction, and when it comes to middle-aged women, one survey found that 42% to 68% said they never or rarely experience sexual desire. Yikes!

So on behalf of women everywhere, let's say thank you to the researchers and their guinea pigs who recently tested a testosterone spray as a possible remedy for women ages 35 to 45.

Although testosterone is thought of as a "male hormone," women do produce the hormone in their ovaries and adrenal glands. While estrogen production starts to plummet around the time of menopause, testosterone declines much more slowly. Can testosterone help you get your mojo back?

To find out, a team led by Susan Davis, MD, PhD, of Monash University in Australia, tested three doses of an experimental testosterone spray (not yet FDA approved, so you can't buy it) against a placebo spray in 260 women.

None of the women had undergone menopause, and all had at least one sexual "event" per month, either alone or with a partner. However, they had all experienced a decline in sexual satisfaction in recent years that concerned them (and had relatively low testosterone levels).

The good news is that all the women had more satisfying sex during the 16-week study. But studies like this often yield murky results, and that's the case here. It's not clear if the spray had anything to do with it. Only women taking the medium dose of testosterone had more events per month (0.8 events to be exact) than placebo users, while those taking the high and low doses had the same amount of satisfying sex as the placebo users. In other words, just being in the experiment may have cause the "more satisfying" result.

"My take-home message from that study was that there’s no evidence now of useful benefit from testosterone in premenopausal women. That was the situation before the study, and that’s still the situation," said Rosemary Basson, MD, director of sexual medicine at the University of British Columbia, who also wrote an editorial published with the study in the Annals of Internal Medicine.

Dr. Basson is concerned about the lack of safety data on testosterone; it's unclear if—like estrogen—it will increase the risk of certain cancers. And an accidental pregnancy while taking testosterone is a very bad idea. It can cause the fetus to develop ambiguous genitalia, or genitals that are somewhere between male and female. One woman in the study had an unplanned pregnancy, but luckily she was in the placebo group and had a healthy baby.

Another potential drawback? Unwanted body hair (hypertrichosis). At the highest dose, 28% of women had hair growth—often at the spot on their belly where the spray was administered.

Experts recommend that women who are worried about their sex life take stock of their mental health (depression is a classic mood-killer) and their relationship with their partner.

"Desire or lack thereof is the canary in the coal mine and tells you something is wrong but doesn’t tell you what is wrong," says Andrew Goldstein, MD, author of the book Reclaiming Desire. "Women can have decreased desire for many reasons. They can have decreased desire because their partner is a jerk. Testosterone isn’t going to make their husband vacuum, take out the garbage, or pick the kids up from school."

However, he thinks testosterone could have potential for some women, and the drug deserves more study.

"Whereas it may be natural to have a decreasing sex drive, that doesn't mean it's necessarily desirable," he says.

'Testosterone link' to depression

Older men with lower levels of the male sex hormone testosterone in their blood may be more prone to depression, a study suggests.
A study of about 4,000 men aged over 70 found those with lowest testosterone were three times more likely to be depressed than those with the most.

Researchers suspect the hormone may affect levels of key brain chemicals.

The study, by the University of Western Australia, features in Archives of General Psychiatry.

Research has found that women are more likely to be depressed than men until the age of 65, when the difference between the genders almost disappears.

Testosterone levels decline with age - but there is wide variation.

The Australian team studied 3,987 men over the age of 70. Each gave blood samples and took part in tests to determine whether they were depressed.

In total 203 of the participants were assessed as being depressed.

They had significantly lower levels of both total testosterone, and free testosterone, which is not bound to proteins.

The researchers then adjusted the data to take account of factors such as educational attainment and body fat levels.

They found those men whose level of free testosterone was in the bottom 20% were three times more likely to be depressed than those in the top 20%.

The researchers said further work was required to confirm their findings.

But their work raised the possibility that treatment to boost testosterone levels in older men may be an effective way to treat depression.

Raised death risk

A previous study of 800 men over the age of 50 found that those with low levels of testosterone had a 33% increased risk of death over an 18-year period than those with higher levels.

They appeared significantly more likely to have a cluster of risk factors associated with cardiovascular disease and diabetes.

This raises the possibility that men with low testosterone levels may be prone to depression because they are also more likely to be in poor physical health.

However, the Australian researchers concluded that this could not fully explain the link, and that some other factor must also be in play.

Testosterone replacement therapy has also been shown to help elderly men with mild Alzheimer's disease.

Research has suggested that levels of testosterone in men of all ages are falling.

Professor David Kendall, an expert in pharmacology at the University of Nottingham, said there was a wealth of evidence to show that testosterone levels were linked to mood.

For instance, farmers had long castrated their stock to pacify them.

Research on animals had also shown that removal of their gonads blocked the action of anti-depressants on key mood-controlling chemicals in the brain.

"It would be no surprise that low testosterone reduces mood," he said.

"Testosterone therapy offers a relatively simple intervention, potentially, for some groups of older depressives with hypogonadism (low production of sex hormones)."

Professor Stafford Lightman, a hormone expert at the University of Bristol, said testosterone potentially had many small effects which could raise the risk of depression. For instance, low levels had been linked to poor cognitive performance.

However, he warned that depression, particularly in elderly people, was often the result of many different, inter-relating factors, and warned against placing too much emphasis on one in isolation.

"My view is that low testosterone could be a contributory factor to depression, but probably not a very powerful one," he said.

http://news.bbc.co.uk/1/hi/health/7274481.stm