Apr
09
2016

Treating Lack Of Sexual Arousal

By | Hormones, premenopause, sexual arousal

A few years back lack of sexual arousal was not discussed that much. But since Viagra has been such a success in males, the search was on for a similar drug for females who have a lack of sexual arousal. The new drug, the “Viagra equivalent for women” is flibanserin under the trade name Addyi.

The news about this new drug has been noted in the media.

How flibanserin works

How does flibanserin work? It stimulates 5-HT1A receptors in the frontal brain to produce more serotonin and dopamine. Due to these substances a premenopausal woman with a lack of desire for sex becomes more arousable. It may sound reasonable at first, but when you look at the many other effects that a stimulation of 5-HT1A receptors can produce, I find it surprising that the FDA gave approval to this drug.

Flibanserin can cause opening up of skin veins leading to hypothermia and fainting due to a lowering of blood pressure. It has some pain relieving properties. Flibanserin can also interfere with learning and inhibit some aspects of memory. Some positives are decrease in aggression, increase in sociability and decreased impulsivity.

Here are a few points that need to be discussed regarding this new drug.

Treating a symptom rather than the cause

Premenopausal women have a lack of progesterone, as their ovaries do not ovulate as regularly as they did in the past. When the last ovulation has occurred, the woman’s periods stop for good. She is said to have entered menopause. There is a profound lowering of estrogen and progesterone levels, which also leads to a lowering of the testosterone blood level. In women the percentage of testosterone is minute compared to men, but testosterone is essential for normal libido. About 5 years before a woman gets into menopause testosterone levels and progesterone levels may already be getting reduced. It is this low testosterone level, which is the cause of the lack of sexual arousal. So, why are we suddenly treating these symptoms with a poorly understood drug? The causes for a lack of sexual arousal are premenopausal hormone changes: mostly lowered progesterone and some lowered testosterone.

Alternative treatment of lack of sexual arousal

Dr. Lee has written several books that became famous. He treated hormone deficiencies in people with replacement of bioidentical hormones. This resulted in feeling new energy and losing the symptoms for which the patients sought consultation. With regard to premenopausal symptoms Dr. Lee wrote the following in one of his books.

It is interesting that these premenopausal women all got help with progesterone cream. Their sexual arousal returned as well as a tiny amount of bioidentical progesterone metabolizes into testosterone, which increases libido in women.

It is clear that Dr. Lee would have done what any anti-aging physician today would do: measure hormone levels and add back the hormones that are missing. In the case of premenopausal women it is mostly progesterone that is missing.

What is better: using a chemical or using a natural hormone?

We need to come to terms with the question: is a chemical like Viagra better for a male to get an erection or natural testosterone?

Viagra and others of that type are drugs that are a foreign substance to the body. There are a significant number of side effects with this medication such as headaches and clotting problems that limit the use for certain patients. Bioidentical testosterone replacement therapy, which can stimulate libido significantly, can often eliminate the need for Viagra type drugs. In the past, with the use of synthetic testosterone, hepatic toxicity and with long-term use the risk of liver cancer existed. Dr. Morgentaler has shown that prostate cancer is not a risk with long-term use of bioidentical testosterone. Also, with synthetic testosterone blood could turn too viscous (secondary polycythemia), which could cause a stroke. The physician has to monitor patients on synthetic testosterone for these side effects accordingly, but this is not necessary with patients on bioidentical testosterone.

If a physician treats a male with erectile dysfunction, he orders a blood test for testosterone. If this comes back with a low testosterone blood level the physician knows what the cause is of the erectile dysfunction. The low testosterone is the cause of erectile dysfunction and therefore treatment consists of bioidentical testosterone replacement therapy. The treatment does NOT consist of a drug like Viagra. Males tolerate testosterone well with no side effects. Instead the man experiences a profound feeling of wellbeing.

The same reasoning is true for a premenopausal woman with a lack of sexual arousal. If she is deficient in progesterone hormone, she needs bioidentical progesterone cream, not a new drug called flibanserin with a myriad of side effects.

Evidence of efficiency of flibanserin in treating sexual arousal

Evidence based medicine scrutinizes research papers to calculate the numbers of patients to be treated before there is one positive therapeutic effect. Researches have defined that a good medical treatment is one where only 50 or less patients get a treatment before one therapeutic success occurs.

The observation from the studies on flibanserin was that satisfying sexual events rose from 2.8 to 4.5 times a month. However, women receiving placebo reported also an increase of satisfying sexual events from 2.7 to 3.7 times a month. In comparison to the placebo there was only a difference of 0.8 times per month that women experienced a satisfying sexual event! If the average American couple has sex 2 to 3 times per week (2.5 times per week), this translates to 10 times per month. We just heard that 0.8 times of these 10 times per months a satisfying sexual event occurred on flibanserin. Flibanserin is taken as one tablet at bedtime.

Compared to the placebo group, it would take 12.5 episodes of sex to generate one event of success (satisfying sexual event), which can be attributed to taking flibanserin daily. The NNT (number needed to treat) is 12.5. However, if you count the number of days of taking tablets, it would take 37.5 days of taking flibanserin to create one satisfying sexual event, so the NNT=37.5. Nevertheless, both numbers would still be acceptable as a moderately effective medicine, as they are below 50.

But I think that we have to be much more cautious in this case as the side effects are considerable and an alternative with no side effects and much more effect exists (bioidentical progesterone replacement).

Consumer education needed

Should the patient trust a physician’s prescription? Then there is the question: should the patient put up with side effects like nausea, tiredness, and difficulty falling asleep or staying asleep, a dry mouth, constipation or excessive sleepiness? Finally, should the patient insist to be educated about bioidentical hormone replacement therapy?

From an evidence-based medicine view bioidentical hormone replacement is the drug of choice. With a number needed to treat (NNT) of 2 to 5 bioidentical hormones have a much higher efficiency than flibanserin. In other words, many women would experience a satisfying sexual event a lot more often. They would experience sexual arousal after having had sex 2 to 5 times instead of 12.5 times.

Bioidentical hormone replacement much safer and more effective

Replacing missing hormones and restoring her hormones to how they were when she was younger should help. The physician ought to explain to the premenopausal woman that bioidentical progesterone replacement is a much safer treatment option. There are no side-effects with bioidentical progesterone. This ovarian hormone has been part of the woman’s  menstrual cycle all along. It is also important for the woman to educate herself about bioidentical hormone replacement and ask questions. Some physicians are of the old conservative school and may refuse this type of approach. In this case it is time to seek out a naturopathic physician.

Treating Lack Of Sexual Arousal

Treating Lack Of Sexual Arousal

Conclusion

Nobody would suggest to treat depression associated with hypothyroidism with antidepressants. Instead the physician treats hypothyroidism with thyroid hormones and the depression disappears.

Similarly, premenopausal syndrome presents with a lack of arousal, a symptom due to progesterone deficiency. This needs treatment with bioidentical progesterone cream. Why would you treat only symptomatically with flibanserin and risk all of the side effects mentioned. It makes more sense to treat the cause (low progesterone) rather than the symptoms. See a naturopath or a physician who understands natural hormone therapy to get the best results.

Jun
08
2013

Breast Cancer Due To Stress

By | Cancer, Health, Hormones, Stress management, Women’s Diseases

The medical profession is of the opinion that breast cancer is multi-factorial, where genetics, body weight, hormonal and other factors play a role in causing it (details see Ref. 1). The Wisconsin Longitudinal Study (United States) showed in May 2012 that girls from families of lower socioeconomic status have a higher risk of breast cancer later in life. The study also showed that girls from families with a higher socioeconomic status had a low risk of breast cancer later in life.

The same cohort of women was the subject of another study, which was just published in April of 2013. In this study the question was asked whether stress in career women could cause a higher rate of breast cancer. Using 1957–2011 data showed that 297 of the 3682 White non-Hispanic women of the Wisconsin Longitudinal Study developed breast cancer. Details of the study showed that the peak of the age for breast cancer to develop was around 55 to 65. Women working with the lowest job authority had the lowest rate of breast cancer. High job authority, being the “boss”, was associated with a 1.57-fold (range 1.12 – 2.18-fold) increase in breast cancer. There was also a striking difference between the lengths of job stress exposure, 5 years versus 15 years with both groups, high and low job authority. The lowest risk of breast cancer was for the low stress group of women who worked under these conditions only for 5 years, followed by the same group who had worked there for 15 years. Slightly above that latter group was the breast cancer risk for the 5-year employed high job authority. The highest group of breast cancer risk, rising above all other groups, was the group with high job authority, exposed to this for type of stressful situation for 15 years (see Fig. 1 of the above link). The researchers interpreted their data to say that the majority of the breast cancer risk in these groups of women was due to the stress hormone (cortisol). Minor contributions were thought to be due to the carcinogenic effect of estrogens.

Breast Cancer Due To Stress

Breast Cancer Due To Stress

 

Review of the literature regarding this study

Dr. Lee had been publishing about estrogen dominance for many years (Ref. 2 and 3). When women age, their ovaries do not produce as much progesterone during the luteal phase as in younger years and above the age of 30 to 35 anovulatory cycles are common. During anovulatory cycles ovulation (=release of an egg) does not occur and there is no formation of a corpus luteum that would produce progesterone for 2 weeks. The end result is that there is a lack of progesterone as a woman ages. This has been discussed in detail in Ref. 3. Dr. Lee called this disbalance of estrogen and progesterone “estrogen dominance”. This is one of the important causes of breast cancer as explained in Ref.2. This can be caused by aging, xenoestrogens from exposure to artificial fertilizers, insecticides and cosmetics, but also taking the birth control pill for prolonged periods of time. However, stress by itself can also produce a state of estrogen dominance. Dr. Lee explained (page 180 of Ref. 2) that the cortisol-binding globulin (CBG), which binds both cortisol and progesterone, is a storage form for both of these hormones. As a person is under chronic stress the CBG is increased binding both cortisol and progesterone. This means that less of these hormones are preliminarily available in their free form for body consumption as CBG binding is a storage form for these hormones. The free progesterone, which is the only biologically active progesterone portion, is lowered as a result of stress causing estrogen dominance. If estrogen is not opposed by progesterone, it is cancer causing for breast tissue and the uterine lining, which translates into being at risk for breast and uterine cancer. Only supplementation with bioidentical progesterone cream as described in Ref. 3 will rebalance the hormones (progesterone/estrogen balance) and reduce the cancer risk. The symptoms of estrogen dominance according to Ref. 4 (p. 29) are fatigue, weight gain, less ability to handle stress, headaches, mood swings, loss of sex drive, irregular periods, uterine fibroids, fibrocystic breasts, fluid retention (particularly around the ankles), irritability and depression.

Practical recommendations for women in stressful jobs

Above the age of 35 it is wise to have a saliva hormone test done, checking the levels of 5 hormones (cortisol, DHEAS, estrogen, progesterone and testosterone). This establishes the baseline values for these hormones. The relationship between the levels of these hormones determines whether they are balanced or not. For instance, if the ratio between progesterone and estrogen (divide the level of progesterone by the level of estrogen) is less than 1 in 200 the patient has estrogen dominance (see Ref. 5). You may need to get a naturopathic physician or an A4M physician who is knowledgeable in interpreting these results and treating the patient with bioidentical hormones. Some women may need to start bioidentical hormone replacement at this point if a hormone deficiency is noticed.

In order to counterbalance stress you need to schedule some time for yourself regularly where you can relax, do yoga exercises, meditation, and/or self-hypnosis. Make sure you get enough sleep. Avoid alcohol, if you can as it interferes with a restful sleep, or reduce alcohol to the absolute minimum. Alcohol causes decreased hormone production of both ovaries. It also weakens the adrenal glands contributing to hormone disbalance. Usually the first hormone to show a decline with stress and aging is progesterone. It has to be measured by the saliva test. Ref. 2 and 3 explain why: progesterone is fat-soluble and is transported through the blood in its free form through red blood cells. However, a progesterone blood test measures the serum progesterone level after the red blood cells have been spun down in the centrifuge, which leads to misleading results; only the saliva test gives reliable results in terms of bio-available progesterone levels. Many conservative physicians blindly insist on blood progesterone levels, which will lead to false results. This is why you need a naturopathic physician or A4M physician to help you with the proper interpretation of the test results.

If saliva progesterone levels are low, progesterone cream (bio-identical, as explained below) is applied daily in a concentration that will normalize the levels. Physicians who have been influenced by drug company representatives may suggest to use Provera (or another progestin, which are synthetic hormone substances) as a “supplement”, but this is known from the Women’s’ Health Initiative to cause breast cancer, heart attacks and strokes.

Do the proper monitoring tests with saliva testing and only substitute what is missing with bioidentical hormone creams. Otherwise a low fat, low refined carbohydrate diet, exercise and other good health habits as I have summarized in this link will be very beneficial to prevent stress as a cause of breast cancer. Ref. 6 is also a useful text written for the layperson explaining what to do when stress leads to adrenal fatigue.

References

  1. A review of the causes of breast cancer: http://www.nethealthbook.com/articles/causesofbreastcancer.php
  2. Dr. John R. Lee, David Zava, Ph.D. and Virginia Hopkins: “What your doctor may not tell you about breast cancer”. 2002 Hachette Book Group, New York,NY, USA.
  3. Dr. John R. Lee: “Natural Progesterone”.  2nd edition. Jon Carpenter Publishing, 1999 Charlbury, England.
  4. George Gillson, M.D., Ph.D.: “You’ve hit menopause. Now what? 3 simple steps to restoring hormone balance” 2nd edition, 2004, Rocky Mountain Analytical Corp., Calgary, AB, Canada.
  5.  John R. Lee, M.D. and Virginia Hopkins: “Dr. John Lee’s Hormone Balance Made Simple- The Essential How-to Guide to Symptoms, Dosage, Timing, and More”. Wellness Central Hachette Group USA, New York, NY 10017. Published 2006. Page 57 discusses saliva testing and states: “The healthy ratio of progesterone to estradiol is at least 200 to 1 and can go up to 1,000 to 1 in women using transdermal (delivered through the skin with cream, gels, oils) progesterone.”
  6. James L. Wilson, ND, DC, PhD: “Adrenal Fatigue, the 21sty Century Stress Syndrome – what is it and how you can recover”; Second printing 2002 by Smart Publications, Petaluma, Ca, USA

Last edited Nov. 6, 2014