News from NAMS part 2: Sex and HormonesThe buzz at the North American Menopause Society (NAMS) conference on day 2 was about the just-released news that Boehringer Ingram, the company that has spent millions of dollars and years of research working on their libido boosting drug, flibanserin, is discontinuing development after negative feedback from the FDA. This is very frustrating. While flibanserin would not have been the answer for everyone, it could have potentially helped many women with low libido.
Moving forward, however, there was some encouraging news for women with decreased desire or painful intercourse. Dr. Jan Shifren, the sex guru from Harvard, presented that while 40% of women have sexual problems, only about 10% find it distressing enough to feel the need to try and fix it. She noted that age, depression and medical issues are more likely to cause a lack of libido than lack of estrogen. Length of a relationship, more than anything else, determined the amount of bedroom activity beyond snoring. Nice to know that you are totally normal if you had sex twice a day when your relationship was brand new but, at year 10, it’s down to once a week (on a good week).
Dr. Shifren emphasized that while testosterone contributes to libido there is very little correlation between specific blood hormone levels and frequency of sexual activity. This explains why it is generally not useful to measure a blood testosterone level. Body image and general health correlate far more accurately with interest and frequency of sexual activity. Therefore, she does not recommend routinely measuring testosterone levels in women with low libido. A few years ago, I had a patient who, at the insistence of her husband, had me test her blood for testosterone. I called her with the news that her level was essentially zero and recommended that she consider supplementation. She responded, “Any more testosterone and I’d be having sex with my personal trainer 3 times a day instead of only twice a day!” Which brings me to the last point Dr. Shifren made: Partner issues, particularly in older women, are often the major problem. “A good man is hard to find,” she noted. “But for older women, a hard man is hard to find”
Dr. Sheryl Kingsberg from Case Western Reserve School of Medicine continued the discussion with prescription options to treat sexual problems. Besides estrogen, there are currently no FDA approved medications to alleviate vaginal dryness and pain with intercourse. While there is no target testosterone level to aim for, many women do benefit from some supplementation, so, since there are no FDA approved options, a lot of testosterone is being prescribed “off-label.” In fact, 20% of prescriptions written for men are actually used by their wives! Warning: Don’t do this without the guidance of a physician who is familiar with dosing or you’ll also be borrowing your husband’s shaving cream and razor.
Dr. Kingsberg emphasized that non-hormonal treatments are often more helpful than hormone therapy. One of the audience members helpfully suggested that, instead of hormone replacement therapy, women should consider “husband replacement therapy.”
Despite the loss of the libido boosting drug, flibanserin, there is still hope; LibiGel ™, a testosterone gel still undergoing clinical trials is moving full speed ahead and, if the FDA approves, may be released as soon as next year. The preliminary safety data was presented and, thus far, is very reassuring with no increased risks of heart disease or breast cancer even in women who had risk factors for heart disease. So while flibanserin will not be an option, it looks like by 2011 women won’t have to borrow their husband’s testosterone gel or rely on compounding pharmacies to get a boost in their libido.