His and Her Health

I would like to know if anyone has had any luck with particular forms of oral or transdermal birth control that didn't diminish libido. I didn't have a problem with my sex drive before taking bc, but now it just seems to have disappeared. My boyfriend and I tried condoms but it just wasn't working. I would rather be on something regularly because I feel safer. Since we are monogomous and have been dating for a year, my main concern is pregnancy, not STDs. <P>I started with Alesse, then tried Ortho Evra, and for the last two months have been on Microgestin. The reason I don't want to give up the bc is that my periods used to be really painful and now I hardly have to take any pain medication at all. They are also about 50% lighter. <P>I've tried a few herbal remedies, but nothing really seems to have helped. Has anyone had luck with other forms of oral bc or other remedies?

Dawn...<P>I don't have personal exp in this area, but I can give you some theoretical advice.<P> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><P>First, hormonal birth control tends to work by a couple of methods. The most common is suppression of ovulation. <P>...<P>One other issue that will be put in context later; if the body thinks it is pregnant, it doesn't cause the surge in testosterone in the middle of the cycle. Thus one might find a loss of desire normally present during mid-cycle or other sexual function problems.<P>One problem is that all these hormonal birth control methods use hormones that are quite different than the estrogens and progesterone that women produce naturally. The estrogens and progestin are synthetic. They do not match the molecular structure of your body produced estrogen and progesterone. There are no real studies that have proven this as problematic, but the medical community hasn't really looked either. <P>So, if you're having problems with a particular type of hormonal birth control, it may be simply the amount of hormone, the particular combination, or the types of hormones. Since there are a myriad of different hormonal birth control, it might be worthwhile to try a different one. Try different dosages and different combinations, tri-phasic or mono-phasic, etc. <P>Another problem that is often seen is one caused by liver first pass metabolism of estrogens. As orally administered estrogen is processed by the liver it causes a rise in another hormone called sex hormone binding globulin or SHBG. SHBG is a naturally occurring hormone. But when it is produced in excess, it can cause problems. Here's why.<P>If you were to go get a hormone test to measure how much testosterone you have, there would be several options. There are tests to measure total testosterone, and others to measure free or bio-available testosterone. In combination, you may have your levels of SHBG tested. Here's how the three things are related.<P>SHBG binds to both estrogen and testosterone. However, it binds to testosterone much more easily and strongly. Any testosterone that is bound to SHBG is unavailable for use by the body. In essence, it's inert, useless. Since testosterone is incredibly valuable in the right amounts for the proper sexual functioning, a significant loss of bio-available testosterone may cause problems for you.<P>The SHBG levels also appear to continue to rise over time. One study found that even at two years, the SHBG levels continued to rise as long as the oral estrogen was in use. So, you may not start out with problems, but find that these problems appear later, or get more dramatic.<P>Testosterone is known to play an important factor in many sexual function areas such as:<UL TYPE=SQUARE><LI>Mood (Depression, blunted motivation, low energy, general malaise)<LI>Libido or desire<LI>Sensation (Loss of sensation in nipples and/or genitalia. Estrogen probably also plays a role here.)<LI>Orgasm (Loss of intensity in orgasm, amount of time and/or effort required to reach orgasm, or even total loss or absence of orgasm)<LI>Minimal Lubrication or other arousal issues.<BR></UL><P>(However, any, some or all of these issues may be present. You might have poor sensation but still orgasm easily, or have low desire, but good sensation and orgasm. Simply because you are not having all of these symptoms is *not* an indicator testosterone and/or estrogen levels are fine. However, the only reliable way to determine what a likely issue might be, is a panel of tests.)<P>So, what can you do to avoid or stop these problems?<P>From the results of studies to date, it's generally believed that only oral estrogens cause these problems.<P>So, if you're on hormone replacement therapy or hormonal birth control, you could switch to a patch or vaginal delivery method. (Estring for HRT, Evra or Nuvaring for birth control.)<P>You could also stop taking the hormones all together. <P>If you stop taking hormonal birth control, you can use an IUD, condoms, cervical cap, or diaphragms, or a completely natural methods such as Fertility Awareness Method or FAM.<BR></font><HR></BLOCKQUOTE><P>You might want to see what other methods that are available. See planned parenthood, they have excellent info.<P><A HREF="www.plannedparenthood.org/bc/" TARGET=_blank>www.plannedparenthood.org/bc/</A><P>Finally, if you decide hormonal birth control is what you really want, then I'd tend to favor transdermal methods, as these tend to raise SHBG levels less. First choice would be NuvaRing, and second, Evra. I've heard several stories about Evra causing GI upset and nausea. This coupled with what I've heard about Evra creating higher serum levels of estrogen would also cause me to generally prefer NuvaRing.<P>I'd generally avoid DepoProvera and Norplant. There are many horror stories I've heard from those who have had ill effects from it. Others, however, believe it's great. I've heard much less about Lunelle, but I'd be wary of it also.<P>Hope that's useful.<P>Best wishes,<BR>Greg<P>------------------<BR>See the icons at the top of this post for my profile and more information.<BR>Also note, I am *not* a doctor, and this is not intended as medical advice - Please talk to your doctor about your concerns.<p>[This message has been edited by distressed_12345 (edited 20 October 2003).]

I've heard that fish oil helps with difficult periods.

Greg,<P>Thank you so much for your extensive reply. I am experiencing almost all of the symtoms you listed for low testosterone levels. I've tried Ortho Evra and it seemed to be the same as the bc pills, so I guess my next course of action is to try Nuvaring or possibly an IUD. <P>Is there a way to boost testosterone levels? I workout regularly and try to eat right (no one's perfect) and yet still seem to be very tired a lot of the time. <P>And yes, I would never recommend DepoProvera to anyone. I took it about 3 or 4 years ago, for about a year, and experienced depression and weight gain.<P>Have you talked to anyone who has tried the Murena IUD? I've read some mixed responses on bulletin boards, but I'm not sure if my insurance covers it so I want to get more information before incurring the cost of it. I know in the long run it is less expensive than bc pills, but the cost is a bit prohibitive at first. <P>Thanks again for you reply.

There are several ways to boost T levels. (I don't believe there are any proven ways to do so "naturally" such as exercise, diet etc.)<P>However, I really believe these are only appropriate after testing free T levels. (See the website in my profile about testing methods etc. These are important!)<P>DHEA will probably raise T levels. Schiff appears to have the best OTC DHEA that most can obtain easily. (Schiff is sold at Costco, and perhaps other places.) I can direct you to a diagram that will show how all the androgen/estrogens/etc are derived from cholesterol. BTW, E is downstream from T. (Ask if you want it.)<P>Topical testosterone is probably more appropriate, but requires a prescription from a doctor. Given the need for testing, this probably isn't too high a hurdle.<P>--- Let me post my canned info about blood testing etc. Also some book recommends. It will be a bit long, but I'd rather give you more than you need than not enough.<P> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>First thing. <P>Call every doc who has run *any* blood work on you for the last couple of years. Request that they either mail, fax, carrier pidgeon, etc *FULL* copies of all results to you. This is really important, and something that you should ask for in the future. <P>(Don't accept *only* a "reading" over the phone, though I'd take careful notes if they offer. Then ask for them to mail or fax. If they refuse, politely inform them that you are legally entitled to full copies of your medical records, and that they need to get with the program.)<P>Post those results here, along with the ranges they give as "Normal."<P><BR>Probably the most important test(s) in relation to desire disorder/ low libido, arousal disorder and sensation issues are:<P><UL TYPE=SQUARE><LI>Total and Free T by equilibrium dialysis if possible (see an explanation of this in the blood-work section of the website listed in my profile.)<LI>Thyroid Function Tests (TSH, Thyroxine/T4)<LI>Prolactin / PRL (A blood test that measures the amount of the hormone prolactin.)<LI>LH / ICSH (Luteinizing hormone) <LI>FSH (Follicle Stimulating Hormone)<LI>Estradiol<LI>SHBG (Sex Hormone Binding Globulin)<LI>DHEA and DHEAS</UL><P>There are some additional issues, if you've not had your tests done yet.<P>Get your Total and Free T levels measured with a test called "equilibrium dialysis." The only other reliable method we recommend is the Free Androgen Index, sometimes also called the Free Testosterone Index, which is the index of Total T/SHBG. This issue is incredibly important. (The cheapest and most widely used test is RIA. RIA is *completely* unreliable to measure T levels in women, especially those levels found in women with very low testosterone. In fact, the FDA is currently working to either force the makers of the RIA tests to show its accuracy in women, or forbid their use in women.)<P>Have your blood drawn in the morning hours, and during the middle third of your cycle, about days 8-15. (This piece is probably not of immense importance, though it currently is thought to give the most accurate picture of your T levels. The monthly cycle doesn't apply to those on hormonal birth control since you're not ovulating. Post-menopausal women don't generally have to worry about either, it appears, and thus blood can be drawn anytime.)<P>The assay methods for all the other tests are generally just fine. <P>The problem with Free T, is the extremely low levels in women. Accurately determining Free T levels, especially at the lower end of the normal range, much less those below the range are very difficult. Equilibrium dialysis is to our knowledge the only assay that can properly determine Free T values over the whole range. <P><B>Notes on the FAI.</B><BR>The Free Androgen Index is calculated by taking Total Testosterone in noml/L and dividing by SHBG in nmol/L<BR>(Total T nmol/L / SHBG in nmol/L)<P>Total T is not often given in nmol/L, but ng/dl. To convert to nmol/L, multiply the value in ng/dL by 3.467.<P>Sources...<BR>FERTILITY AND STERILITY<BR>VOL. 77, NO. 4, APRIL 2002 (Portions of entire supplement.)[/b]<P></font><HR></BLOCKQUOTE><P><BR> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR><UL TYPE=SQUARE><LI>I'm Not in the Mood: What Every Woman Should Know about Improving Her Libido, by Judith Reichman - Score, 9/10 (Recommended)<BR><LI>For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life, by Jennifer Berman - Score 8/10 (Recommended)<BR><LI>Resurrecting Sex: Resolving Sexual Problems and Rejuvenating Your Relationship by David Schnarch (One really doesn't need both of David Schnarch's books, but both are good and somewhat different. Resurrecting Sex discusses both medical and psychological causes for sexual dysfunction, where Passionate Marriage only reviews the psychological, though it's an excellent book.) (Recommended)<BR><LI>Passionate Marriage: Love, Sex, and Intimacy in Emotionally Committed Relationships, by David Schnarch - Score 8/10 <BR><LI>The Hormone of Desire :the truth about sexuality, menopause, and testosterone by Susan Rako - Score N/A (Older book, Copyright 1996) <BR><LI>Getting the Sex You Want, a Woman's Guide to Becoming Proud, Passionate, and Pleased in Bed by Sandra Leiblum, Ph.D. and Judith Sachs. </UL><BR></font><HR></BLOCKQUOTE><P>I've post-fixed the few I think would be best, or most productive. However, all are very good. I've read them all.<P>If you have more questions, let me know.<P>Best wishes,<P>------------------<BR>See the icons at the top of this post for my profile and more information.<BR>Also note, I am *not* a doctor, and this is not intended as medical advice - Please talk to your doctor about your concerns.

Actually, concentrations of free testosterone in the peripheral blood are a poor reflection of intracellular androgen receptor stimulation. So blood tests are of little use. In addition, when an androgen problem is present (not common), libido problems are better treated orally, with a low dose testosterone capsule from a compounding pharmacy. Testosterone cream can be effective in increasing genital sensation in women, but not for primary libido problems. Testosterone cream can be used as a supplement to oral capsules, if both problems are present.

I am so amazed by the amount of information on this bulletin board and by the speed at which I get replies -- thank you!<P>I ordered the "I'm not in the mood" book and will see what it has to say. Meanwhile, my annual exam is the first week of December so I will call my doctor in advance to see if she can do the blood tests you recommended. Are these tests that I should fast for? Some work better if you haven't eaten for 12 hours, but I'm not sure about this one.<P>I am going to go on vacation for a few days so hopefully the rest will have a positive affect as well.

dawn-<P>Why not go off the birth control for a few months to see if that is indeed the issue? If your libido returns, then you know for sure it was the birth control. It's easier than continuing to switch birth controls or adding yet another medication like testosterone and waiting another 6 months to see if it has an effect. A blood test isn't going to be definitive.<p>[This message has been edited by Bihag (edited 21 October 2003).]

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>... libido problems are better treated orally, with a low dose testosterone capsule from a compounding pharmacy. Testosterone cream can be effective in increasing genital sensation in women, but not for primary libido problems. Testosterone cream can be used as a supplement to oral capsules, if both problems are present.</font><HR></BLOCKQUOTE><P>Unless you're using Methyl-testosterone (which is not bio-identical testosterone, though it has similar effects), most of the testosterone is lost during first pass metabolism when taken orally. MT (methyltestosterone) as I've said in other posts has some very unique properties that can make it a sensitive product to use. These can make its use difficult, especially if not overseen by a doctor with extensive experience in treating these issues with that particular drug. (This is an area in which I'm intensly skeptical about - there are relatively few physicians in the US that I'd consider of adequate skill to treat FSD in general, and only a few of those who I think really understand and can manage MT appropriately.)<P>Topical (transdermal) use is more even in it's titration of T in the blood stream IMHO. T levels tend to have a fairly smooth cycle day to day. Other methods of T use don't produce this. Exactly what effect this might have is unclear. However, I'd prefer a method that most closely mirrors what the body produces naturally. I think transdermal methods do that. Finally, MT is not bio-identical to the T produced in your body. Again, I'd prefer to mirror, if possible, the stuff your body produces - transdermal, bioidentical T does this best IMHO.<P>If you'd like some data on MT and it's problems, I'd be glad to give that to you as well.<P>The use of T for libido is quite well documented. Exactly what portion of the population will benefit most is unclear however. (Some see tremendous relief, others seem much less, and a few don't seem to respond at all.)<P>For specific, first hand knowledge...we have used Androgel (topical/transdermal T) for virtually all the above listed symptoms and have seen significant relief on all counts. In some area's the change was very dramatic.<P>What would be most useful, vis-a-vis the birth control, would be a SHBG test. This would tell you how much the SHBG levels were boosted by oral BC use, and give you some idea how much a bounce getting away from OC's will help in the Total T/Free T/SHBG mix. In our case, even having been on OC's for more than 10 years, the SHBG levels we had were moderate, and even a massive decrease in the SHBG levels would not have increased the FAI/Free T levels to anywhere near "normal" levels.<P>(However, I'd recommend all the tests highlighted above. *All* can have significant impact, and to get a *complete* overview of the "whole" you, all should be done, and reviewed by someone who is able to properly understand them. -This does cut out a significant number of physicians. You'd be surprised how many don't know how to interpret these blood tests properly, but that's a whole 'nother subject.)<P>I just want to make clear that TSH, Prolactin, Estrogen and others can have dramatic effect - I've just highlighted T because it *may* be related to oral contraceptive use.<P>Thus, without diagnostic tests, it's difficult to say exactly how much any trial run of any hormonal birthcontrol, or lack thereof, might have.<P> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>Are these tests that I should fast for? Some work better if you haven't eaten for 12 hours, but I'm not sure about this one.<BR></font><HR></BLOCKQUOTE><BR>Fasting isn't needed for any of the tests I've outlined.<P>If you're not on a hormonal BC method, the tests for Free T ought to be done mid cycle in the AM hours. If you're not ovulating because of BC, then there is no mid-cycle surge of T, and thus you should get it drawn in the AM hours when T should be highest - the position in the monthly cycle isn't a concern. This will give you the best, most conservative estimate of what your T levels are.<P>Final notes.<BR>There are a number of drugs that can cause problems. One example: SSRI Anti-depressants such as Prozac. <P>Can I ask what other medications you're on?<P>Also, how about your age and physical health?<P>Finally, I assume you'd have brought it up earlier, but what is your partner relationship like? Your own mental state?<BR> <BR>Best wishes, <BR>Greg<P>(Sorry for the massive post again... There are a whole lot of variables and possibilities. I just want to make sure I cover all the bases and let you decide what makes sense to you.)<P><p>[This message has been edited by distressed_12345 (edited 22 October 2003).]

Testosterone cream will not work for you if you have decreased testosterone receptors or a reduced enzyme function. What some view as "natural" doesn't always mean "better". Methyltestosterone is preferred over "bioidentical" testosterone. Bioidentical testosterone converts readily to estradiol in your body, so it is more difficult to control the dosage and keep levels stable. And some women who are at risk for breast cancer want to keep their estradiol levels down. The most effective dose of methyltestosterone is 0.25 to 0.75 mg. A woman should try such a low dose for several weeks before increasing it. If her low libido is related to some other reason or if her problem is not the amount of testosterone, increasing the dose will have no effect. Methyltestosterone can also be formulated in sublingual tablets and gels/creams. Many women benefit from starting with methyltestosterone cream applied to the vulva for a month or two until genital sensation returns (if that was a problem), then switching to .25mg oral. Keeping in mind that only a small percentage of women with low libido will be helped with testosterone supplementation, many physicians recommend attacking the problem in this order: psychosocial evaluation, estrogen evaluation, and lastly, testosterone. Dawn has jumped on her birth control as the culprit, when it may well have nothing to do with her low libido, especially considering other factors involved at the same time (new relationship, for one).

Dawn,<P>Yes, you can increase your testosterone levels naturally, through diet, exercise, stress reduction (reducing cortisol, which correlates negatively with sexual arousal), sexual activity, and more. For obvious reasons, balancing (increasing some, decreasing others) your endogeonous hormones naturally is a better long-term lifestyle-changing solution. You want to move toward a way of living that optimizes your own body’s ability to produce the hormonal balance most needed. Simply taking exogenous testosterone may not be the best solution for your body.<P>Sexual Activity...<BR>DHEA, a popular supplemental hormone, is released naturally during lovemaking. Just before orgasm or ejaculation, DHEA spikes to levels three to five times higher than usual.<P>Exercise...<BR>Physical exercise (3+ hours per week) changes your hormonal balance (testosterone, cortisol,..) in a positive way (cortisol, which directly inhibits sexual arousal, falls quite significantly during and after exercise). Both a lack of exercise and excessive exercise (over-training) will reduce your testosterone levels. Because you require testosterone for repair and growth, do not exercise for more than 45 to 60 minutes at a single session.<P>Stress reduction...<BR>Emotional stress is a frequent cause of decreased testosterone levels. When the "fight or flight" alarm reaction system is active, stress hormones such as adrenaline, noradrenaline, and cortisol are released. These hormones that are released to protect our lives have catabolic activity. This means they catabolize (breakdown) body stores of fat and protein to be used for acute resources of energy and immune response. They go even one step further and inhibit all anabolic processes as well. Because in life or death situations the body does not need to build muscle, eat, have sexual thoughts etc. processes that require vital life energy, all anabolic (building) processes including testosterone can be shut down. Today stresses are not only prolonged but perceived in our mind. And this chronic stress causes an over-activation of our adrenal system and the catabolic process. In fact, chronic catabolism is not only the greatest cause of premature aging and cardiovascular disease but it inhibits testosterone function. Follow the advice, "Don’t sweat the small stuff and it is all small stuff", stay well rested, and take your time eating frequent small meals. This will help normalize cortisol levels and allow your anabolic system to take over again.<P>Diet...<BR>1) Eat moderate amounts of protein. Protein stimulates the hormone glucagon and the anabolic (muscle building) responses important for adequate testosterone release.<BR>2) Eat more vegetables and fruit and limit excessive carbohydrate intake especially of simple sugars and starches (grains, potatoes, pasta). Excess intake of carbohydrates especially those that raise blood sugar rapidly create chronically elevated levels of the hormone insulin and cortisol. These two hormones oppose the action of testosterone and diminish it’s production.<BR>3)Eat fat. Essential fats such as the omega 3 fatty acids found in fish and flaxseed as well as saturated fats are essential for normal testosterone production. All steroid hormones are produced from cholesterol and when fats are deficient in the diet, this process will be inhibited. Studies clearly indicate that low fat diets results in lower testosterone levels while those higher in protein, lower in carbohydrate and moderate in fat cause the greatest sustained levels of testosterone and growth hormone. If your diet is very low in fat and high in complex carbohydrates and fiber, your testosterone levels may remain low.<p>[This message has been edited by conner (edited 22 October 2003).]

RE: DHEA<P>"DHEA can cause undesirable side effects, including acne and hair loss on the head. Other reported side effects are weight gain around the waist and increased blood pressure. In men, it could result in aggressive moods and behaviors. In women, it may cause changes in menstrual patterns, unwanted body and facial hair growth, and deepening of the voice. Side effects can be worse with higher doses. Because supplements like DHEA are not well studied, the supplement may cause side effects that haven’t yet been discovered.<P>You should use DHEA under a doctor’s supervision, especially if you have diabetes, psychiatric conditions, or liver problems, or are at risk for cancer. And tell your doctor immediately if you think DHEA caused one or more of the side effects listed above or any other health problem.<P>Sources:<BR>The Natural Medicines Comprehensive Database. Pharmacists Letter Inc., 2000.<BR>Micromedex Healthcare Series. Micromedex, Inc., 2000.<BR>Skolnick, A. “Scientific verdict still out on DHEA,â€

I agree. DHEA supplementation requires a lot of regular monitoring. One clinic I know of prescribes it regularly. I feel they are using their patients as guinea pigs. Most others stay away from recommending it until more research is done on safety.

I tried 25mg of DHEA daily for about a month and didn't really see any difference. That may not have been long enough. I also tried an herbal remedy with damiana along with some other herbs. At this point, I think my only real option is to go off the bc for awhile and see if it helps. <P>I've tried raspberry supplements before and they seemed to help with cramps and made my period less heavy. If anyone has any other suggestions for this, please let me know. The bc has been amazing in this department and I hate to lose those benefits.

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>I tried 25mg of DHEA daily for about a month and didn't really see any difference. That may not have been long enough. I also tried an herbal remedy with damiana along with some other herbs. At this point, I think my only real option is to go off the bc for awhile and see if it helps. </font><HR></BLOCKQUOTE><P>I don't really advocate DHEA without oversight and care from your doctor, but that said...<P>I don't think a month or two would be nearly enough. For us, even T didn't make much difference for several months. DHEA is going to take longer, perhaps much longer, from anecdotal evidence I've seen.<P>If you haven't tried NuvaRing, I'd really see if that works. I expect it will regulate your period as you would like. What I don't know is, will it be better than OC's for the libido and energy issues. Perhaps, perhaps not. It will have less raising effect on SHBG, but we're not completely sure that's a significant part of the problem. <P>I think some peri/post menopausal women use used black-cohash and horney goat weed for their symptoms, but I have no idea on its effectiveness. <P>(I asked some questions above, that might look more deeply into root causes. If you are willing, discussing the answers to those questions might be helpful. I don't want to push, but I'm a strong believer in looking at all aspects rather than limiting the preview to what I might think makes sense.)<P>I'll be quiet now unless you want to follow-up. I truely hope you find some answers.<P>Best wishes,<BR>Greg<P>------------------<BR>See the icons at the top of this post for my profile and more information.<BR>Also note, I am *not* a doctor, and this is not intended as medical advice - Please talk to your doctor about your concerns.