His and Her Health

Well, I'm a new guy here, so be gentle. <P>I want to get some feedback on the issues that my wife and I are having. I've read a number of similar posts, but a lot of it was rather dated, so I wanted to get some fresh views.<P>Ok, here's the deal. My wife and I are in our early 30's and have no children. My wife has severe chronic allergies that cause her health problems, though I don't think they have a lot to do with this situation. When we first got together, and pretty much until she started taking the pill, we were very sexually active. However, now that she is on the pill, she has no sex drive whatsoever. For the longest time, I thought it was me, or she was just holding out. It's been like this for almost 3 years now and we've had sex a total of 4 times in that time. Now, I love my wife and sex is very low on the list of reasons why I married her. Still though, I'm an extremely sexual person and miss that intimacy with my wife just about more than I can stand it. I usually take care of buisness on my own at least 4-5 times a week to keep my primal instincts at bay. I'd like her to help, but I have to much respect for her to make her feel like some kind of male masturbation tool. Plus, when she sees me getting off, it really upsets her because she wishes she could be a willing participant. She's even offered to just "lay there", but there's no way I'm doing that. It would seem more like I was raping her than anything.<P>Anyhow, we are quite aware that the pill is the cause of her issue. She started taking the pill to deal with Endometriosis (SP?). We explained the problems to her GYN and she gave her a 2% testosterone cream just like I've seen a lot of other people mention. She applies it to her arm which I see as a little weird, but that's what the doc said. Well, it doesn't seem to be helping in the slightest. Her pills can't be changed because according to her doctor, they are the most "neutral" of all the ones available. If she uses too high of a dose of the cream she gets really irritable. Kind of a violent irritable if you know what I mean..<P>The GYN also reccomended another cream for us to try. Considering the ridicuolous price and the lack of legitimacy (no FDA) we were hesitant. We went ahead and got a "sample pack" and she has used it 3 times now with no impact whatsoever. It says you need to use it for about 60 days, but I'm not shelling out $200 for a "miracle cream" that doesn't have any legitimacy to it. Especially when there is a strong chance that it won't do a thing.<P>Until I got to this board, I figured we were very much alone in our situation, but it's good to know that others know what we are going through. We thought about going to a specialist for the issue, but from what I've seen, there really isn't a point. Everything we've seen has more to do with getting a woman to understand how her body works and things like that. Well, when she was healthy she would take care of her own buisness all the time too. She used to regularly orgasm with or without my assistance, so it's not an issue of not knowing how to please herself. <P>The problem now, is that she just doesn't have any interest in trying. She's even forced herself to an extent by watching movies that used to really get her going. Alas though, not a single thing. She describes it like if I tried to rub my knee for an hour to get an orgasm. Just doesn't work at all. It's slightly relaxing, but that's about it. Now when she watches steamy scenes she compares it to being as sexually enticing as a dog show.<P>We know she needs something to get her over this, but we have yet to find anything legit that we haven't tried or that isn't practical. For example, that EURO machine looks like a suped up vibrator. We can do the same thing that machine does with a little oral from me. That's not going to help much though because she still has to WANT to do it.<P>So my question is what is the status of products for women like Viagra? Is there anything else out there that's even somewhat legit that we could try? Or are we at a point where we just need to sit and wait for the medical community to get their act together? Any suggestions, ideas or anything at all would be greatly appreciated!<BR>

I am really sorry to hear about your wife's endometriosis, and the issues it's causing both of you. It's good that she realizes sexual contact is important to you, and to your marriage. It's also excellent to hear how supportive you're being. <P>First, let me say that Viagra won't help your concerns regarding her libido. It's isn't made to help libido in either men or women, but to increase blood flow. In men, this can aid erection. In women, this can aid in lubrication and sensation. If her problem is that she doesn't lubricate well, or that she has serious sensation problems not related to lack of libido, it might be an idea to ask your physician for a sample (they can do this off-label). If her lack of sensation, however, is due to lack of interest/libido Viagra is not going to do anything to help that. Currently, as far as I know, there isn't a magic pill for women's libido issues, and your wife is going through a lot. It's wonderful that you've been so supportive, and I do very much understand your interest in maintaining a healthy and active sex life. Unfortunately, between her allergies and her endo, it may be a difficult solution.<P>As you mentioned, the pill can cause reactions like this; but, so can the endometriosis. Sometimes it appears the loss of libido is a reactoin to the fact that sex has become painful, other times it appears that libido often just goes away in women with endometriosis, even if sex hasn't become painful. Does she belong to any endo support forums? There are several, and often issues like this are addressed. It can be very helpful to find out what other women and couples have done to get through this situation. The pill may not be the only answer for her endo, btw--there are other treatment options. She should research and discuss these with her doctor, and the support forums can really help with this. You are definitely not alone (I have several friends, actually, who've gone through the exact same thing).<P>Also, in her case, 2% T cream may just simply not be enough to counteract her libido issues if the pill is seriously affecting her hormonones. Conversely, if her T isn't low in the first place (her free T), it may not help her at all. Endometriosis is very hard on women, and often libido simply becomes non-existant. I've heard this from every single one of the women I know who's had endo, so I gather it's a fairly common occurance. One is working on getting her libido back after having a full hysterectomy, and is slowly making progress. Another has no interest at all, and is on lupron.<P>I would really recommend finding a support group online, or one nearby in your hometown (you'd be suprised at how many there are), and seeing what's worked for others in situations similar to yours.<P>Good luck in your search.

Well, first off thank you for the timely response. We tend to be very private people, so I can't see a support group happening. (Frankly she'd kill me if she knew I had posted anything here.) It's not that she's all that embarassed by it, she just doesn't like talking about things like this with "strangers". <P>Her endo doesn't really seem to be much of an issue any more. Though I can't say she is exactly cured of it, all the symptoms are gone and her periods no longer cause her to feel like someone just stabbed her with a broken bottle. <P>Now, I've been doing some more research on these forums and ran across one thing that sounds rather interesting. Can anyone tell me about their positive or negative results with "Damiana"? This seems to be the closest thing there is to a sexual stimulant in women. The best part is that it was used by Native Americans in the past, so she might be receptive to that idea since she is 1/4 American Indian. <P>Other than that, I guess my earlier statement was pretty accurate. That is, just hang in there until someone can figure out an appropriate medication.<P>Oh btw...if anyone was going to ask, we did a full hormone workup on her at her GYN and she indicated her testosterone was slightly lower than normal, but nothing too bad. That's why she suggested the 2% cream. <P>So, again, any thoughts on "Damiana"?<BR>

I don't think damiana will help in your case. At least not much. It helps women who are tense during sex, makes them feel relaxed and uninhibited.<P>I'm not a doctor, but I think the solution to your problem is pretty obvious. Get off hormonal birth control. There must be something out there besides hormonal birth control that helps her endo. Get a second opinion from another doctor, search around on the Internet for alternate treatments. Lots of women have serious libido problems with hormonal birth control. Adding some kind of "aphrodisiac" on top of it won't help.

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2">Oh btw...if anyone was going to ask, we did a full hormone workup on her at her GYN and she indicated her testosterone was slightly lower than normal, but nothing too bad. That's why she suggested the 2% cream.</font><HR></BLOCKQUOTE><P>A few thoughts and questions. I'd get copies of the labwork results, that way you can be sure what was checked and what the results were.<P>Testosterone assay's in women are very difficult to do right. About the only reliable assay for women is equilibrium dialysis. If your Free T or Total T test wasn't done using these methods, then the accuracy and reliability of the test are likely not good. (If you're unsure, call the lab, the number should be at the top of the report, and ask.)<P>Next, what tests were done. T is only one of the hormonal issues you need to check. Others are:<BR>Thyroid Function Tests (TSH, Thyroxine/T4)<BR>Prolactin / PRL (A blood test that measures the amount of the hormone prolactin.)<BR>LH / ICSH (Luteinizing hormone) <BR>FSH (Follicle Stimulating Hormone)<BR>Estradiol<BR>SHBG (Sex Hormone Binding Globulin)<BR>DHEA and DHEAS<P>I suspect you might only have had a total T lab run. Yet your SHBG numbers may be quite high. This means that Free T may be quite low.<P>(I'm sure you're thinking - well we used 2% T and it didn't work, so that must not be the problem... Perhaps. But compounded creams can have pretty wildly differing absobtion rates - perhaps it was too low, or you were applying too little to be effective. Next, how long did you use the cream. Anything less than 3-6 months is simply not long enough. Androgel is a mass produced T gel - 1% - and may be a better choice. Testim is another option. I'm not saying what was done was all wrong, but that it might be. I've seen it before, even personally, and just want to make sure all the details are right.)<P> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>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>Notes on the FAI.<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>Example: Total T of 10ng/dL = 353.634 nmol/L.<BR>If SHBG was 80 nmol, the FAI would be 0.4333.<P></font><HR></BLOCKQUOTE><P>Finally, an explaination about SHBG, oral estrogens, and free T.<P> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>Oral administration of Estrogens (including CEE) causes the liver to increase production of SHBG. This is important because SHBG binds to Testosterone (T) very tightly. The result is that T, bound to SHBG is not available for the body to use. Thus, high levels of SHBG can result in extremely low levels of Free T, sometimes called bio-available T. Transdermal application of estrogens, does not appear to cause the same rise in SHBG levels. Thus, provided the loss of libido that some women experience, is due to a loss of Free or Bio-available T, this problem may be rectified by lowering SHBG levels by changing hormonal birth control to a non-oral method. (Currently (Aug 2003) the only non oral hormonal birth control methods are: NuvaRing, Evra, DepoProvera, Norplant, and Lunelle.) Also, obviously, ceasing hormonal methods of birth-control is another option. For information on virtually all the methods of birth-control, see <A HREF="www.plannedparenthood.org/bc/" TARGET=_blank>www.plannedparenthood.org/bc/</A><P>[Sources: Ibrahim Serdar Serin et al. European Journal of Obstetrics and Gynecology and Reproductive Biology 99 (2001); 222-225.]<P>Numerous users have problems with many of the hormonal birth-control methods. Though there has been little in the way of scientific study on these issues, we hear regular "horror" stories about virtually all methods of hormonal birth-control. Most notorious are: Depo-provera, Norplant, and the higher dose Oral contraceptives. <P>Some of the oral contraceptives are billed as a "cure" for acne, and for some they are. However, the binding of testosterone via increased SHBG production is the key to this process. Higher testosterone levels often cause more oily skin. This in turn can increase the prevalence of acne. However, the decrease in acne may also be accompanied by a dramatic loss of libido. <P>Also, loss of libido and other problems may develop over time, rather than a rapid onset beginning with the use of the product. It appears as though SHBG levels rise and Free T levels fall continuously over time, for on average at least two years. (Longer term effects are not known. The limits of the study on this subject was two years.)<BR></font><HR></BLOCKQUOTE><P>For OC's, I'd recommend:<BR>NuvaRing<BR>Evra<BR>Loestrin 1/20<BR>Alesse, Levlite<P>These are all quite low dose estrogens and should probably cause less SHBG production. The first two are transdermal and should avoid any increase in SHBG levels.<P>Some people like depo-provera for Endo, but I've heard evil stories about the effects of D-provera - consider carefully before using.<P>Perhaps more later. I've been very busy.<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 14 November 2003).]

OK, just so you know you're NOT alone - this could have been written by MY husband - similarities are uncanny. No real answers for you since I'm in the same boat, but just a note: I was on birth control pills, stopped them months & months ago and not a thing changed. Sorry, but it really didn't. Good luck. Your post was very interesting, well written & I look forward to seeing the replies you get.

I question the correlation of his wife's low libido with the pill. Patients often pick something that seems to be an obvious cause for when their symptoms "started", when the timing was just a coincidence. I doubt the pill has much to do with it.<P>

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2">Originally posted by distressed_12345:<BR><B> 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.)</B></font><HR></BLOCKQUOTE><P>What is your source for this statement? I believe the data supporting it are sparse, based on very little data, and found mainly in a couple letters to the editor. Please post your source. Thank you. Equilibrium dialysis is difficult to perform and not suitable for most laboratories. The calculated free androgen index is the most acceptable approach at this time.<BR><p>[This message has been edited by Owner (edited 15 November 2003).]

<B>Owner</B><BR> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2">What is your source for this statement? I believe the data supporting it are sparse, based on very little data, and found mainly in a couple letters to the editor. Please post your source. Thank you. Equilibrium dialysis is difficult to perform and not suitable for most laboratories. The calculated free androgen index is the most acceptable approach at this time.<BR></font><HR></BLOCKQUOTE><P>I find it a bit amusing that you want to bash me for not posting my source on this, but then you make your own completely unsupported statements and leave out sources? I remember something about people who live in glass houses.<P>Also, you seem confused. There is a "Free Androgen Index" or FAI and there is the "Caclulated Free Testosterone" using the Sodergard equation. There isn't such a thing as the "calculated free androgen index."<P>Finally, I can personally tell you that getting a Free Testosterone test using the EqD assay type is really easy. All you need to do, is get the physician to specify "Free Testsosterone by Equilibrium dialysis." The lab then, will probably send the sample to Quest or Mayo or some other lab that is equipped to do them. (I know both of these labs do FT by EqD and there are probably others) <P>We've had no fewer than 5 of these tests, so I speak from experience. I expect the total cost of doing all the test required for a CFT, vs. a Free T via EqD isn't much different. In fact, I'll bet it's cheaper to get a Free T via EqD.<P>Next, since most docs don't even know not to use RIA, getting them to understand how to do a CFT is even more unlikely. I expect for many who read my posts and act on them, they may try to get their local doctor to run some of this blood-work themselves. Since it's lots easier to simply read the result of a Free T test than to explain how to do the FAI or CFT, I think Free T is more suitable. (Can you explain to me how to correctly calculate the Free T in the CFT test, and exactly which tests are needed to calculate it? I'd be very supprised if you can without having to look it up.)<P>Finally, I'll humor you and give you my sources. <P>Best Practice & Research Clinical Endocrinology & Metabolism<BR>Vol. 17, No. 1, pp. 165–175, 2003<P>The Journal of Clinical Endocrinology & Metabolism<BR>Vol. 84, No. 6<BR>Androgen Replacement in Women: A Commentary<P>FERTILITY AND STERILITY<BR>VOL. 77, NO. 4, APRIL 2002<BR>Female androgen insufficiency: the<BR>Princeton consensus statement on<BR>definition, classification, and assessment<P>In summary: I'm sure the FAI and the CFT are reasonable methods, they are, however, not very straight-forward. Getting a Free T via EqD isn't difficult at all, it's really fairly reasonable in cost. (Quest's retail non-discounted pricing, IIRC, the last time I checked was ~$100.) Getting a doc who isn't a serious specialist in FSD to even understand that RIA isn't an appropriate test for women, and further, to do the right things to calculate the CFT is very unlikely. Thus, I think for most, Free T via EqD is most appropriate - it certainly is accepted as as accurate as you can get at the current time. (It appears your motivation in muddying the waters is to make it as difficult as possible for anyone to actually get a Free T test, and do it right, as you seem to violently disagree that it's a useful test. Or perhaps you're just being a troll and trying to waste my time. In any case, here's the information.)<P>I wish you well, and hope that someday you allow your patients, and others, to actually use their own heads and direct their own care rather than sermonizing about how "they are normal" and just basically "get over it" when they clearly know something isn't right.<P>Cheers,<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><p>[This message has been edited by distressed_12345 (edited 16 November 2003).]

I have never had a problem having my free testosterone levels performed by equlibrium dialysis method. As I recall, Dr Andre Guay and others who are experts in female sexual problems recommend that free testosterone blood levels be peformed by that method.<P>My doctor orders it through Mayo and specifically requests it. It was no more expensive than the other methods.<p>[This message has been edited by Iam (edited 16 November 2003).]

I was only asking where you learned this: "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>Do you have a source for this? Thank you.<P>My source is Andre Guay:<P>The most common assay performed in the United States is the analog free testosterone assay. It is quite reproducible and is less labor intensive. However, it is considered by many to be the least accurate assay, though the data supporting this are sparse; these objections are found mainly in a few letters to the editor.<P>The measurement of free T by equilibrium dialysis is regarded by most as the gold standard and recently has been modified to be more sensitive at lower blood levels, but it is difficult to perform and not suitable for most laboratories. Other assays for free T are generally felt to be lacking, although the evidence to suggest this is controversial and based on very little data. Adequate comparative trials should be carried out. The calculated free-T assay seems to be the most acceptable approach at this time, but again data are minimal, and it needs to be tested in larger populations. Most reference laboratories can easily do the total T and SHBG assays needed to calculate the FTI.<P>Guay, AT. Screening for androgen deficiency in women: methodological and interpretive issues. Fertility and Sterility, 2002;77(4):83-88.<P><BR>Many clinicians use a calculated free androgen index to estimate physiologically active testosterone. This index is typically calculated as the ratio of total testosterone divided by SHBG and multiplied by 100 to yield numerical results comparable in free testosterone concentration.<P>Free Testosterone by Equilibrium Dialysis:<P>The measurement of free testosterone in serum is technically demanding. The concentration of free testosterone is very low, typically less than 2 percent of the total testosterone concentration. Routinely available assay methods are not sensitive enough to quantitate free testosterone directly. Instead, free testosterone is often estimated by indirect methods. In these methods, tritiated testosterone is added to the sample and allowed to come to equilibrium with testosterone in the serum at physiological temperature. The amount of the added radiolabeled testosterone must be low enough to ensure that the addition will not significantly increase the total testosterone concentration. Once equilibrium is achieved, the free testosterone is separated from the bound by filtration through a membrane. This filtration can be accomplished by equilibrium dialysis or by centrifugal ultrafiltration. The radioactivity of the protein-free ultrafiltrate is measured and used to calculate the percentage of free testosterone. The concentration of free testosterone can then be calculated by multiplying the percentage of free testosterone by the total testosterone concentration. Measurement of free testosterone by these methods is not available in most clinical laboratories due to the complicated nature of the testing and the requirement of a scintillation counter to measure the tritiated testosterone concentration.<P>[This message has been edited by Owner (edited 16 November 2003).]<BR><p>[Note: This message has been edited by NEWSHE Moderator]

Again, thanks for all the responses. Though I did get a nice chuckle at the technicality debates. LOL!!!<P>Well, we've basically gotten to the point where we know we are just stuck. We've talked to her GYN repeatedly about the pill, and that's really her best option to deal with the problems she has.<P>She's been using the 2% for about 6 months now and she says there is a slight difference, but nothing too significant. If she uses it too much, she gets cranky, so we just keep to the standard. I am curious though, what is the usual reccomendations for frequency and location of use? She uses it every other day and applies it to her underarm. Does this sound common, or normal?<P>We both agree that they probably didn't do as detailed a workup as what Greg listed, but we've taken good notes, and that will be on our list for the next visit. <P>Owner brought up something that I have considered and that is that she isn't really reacting to the pill as much as possibly something else. Could this be a side-affect of clearing up her Endo? The timing otherwise, is 100% dead on to when the pill started.<P>Finally do most insurance companies cover this kind of stuff? I can't see many insurance companies assisting with bills where the woman is trying to "get some". LOL! (Lack of a better term...no offense) That is, do they cover these special hormone test and such?<P>Oh and one last thing. Realisticly and honestly. Is there anything being studied right now that might give us and others like us hope? I've seen vague references to things being researched, but it was all dated 02 or prior. Anything current? What kind of things are being looked at? How long (ballpark) do you think it will be before a realistic marketable and FDA approved solution (or attempted solution) might be available?<P>Thanks again folks!!!<BR>

I'm about to start my dietary research, and I know other things are being researched as I type. Don't hold your breath, though, I think it's the birth control pills. There has been research done showing a substantial minority of women have pretty big drops in libido on hormonal birth control.<P>I would get a second opinion on the endometriosis from another GYN. I just did a quick Internet search myself on the topic, and found an FAQ saying oral contraceptives aren't usually used anymore to treat the condition, instead danazon and GnRh-agonist are used. Also something called Gestrinone, which works by increasing male hormones in the body (and libido-wise, that's a good thing).<P>Of course, this is secondhand off the Internet, but it certainly can't hurt to get a second opinion from another GYN. I even found that the condition can be treated just with testosterone. Read up on it. My favorite supplement, that I seem to push for everything--high dose fish oil--has shown good results in animal studies on endometriosis. And I am pretty sure that fish oil does help with a woman's libido, especially when you are taking large doses of it.<P>There's no magic bullet for female sexuality like Viagra. Trust me, I know.

Well, not to be too subtle, but that just sucks!!! LOL!<P>Well, we had her start with Fish Oil supplements, so we'll see how that goes. <P>I agree that odds are is that it is the BCP causing the problems. It just seems the most logical because before that she was doing just fine. Well, that is, other than the lovely glass shards sensation she got on a monthly basis. <P>Looks like we will be making more GYN appointments before too long. Thanks for the help gang. If we find anything that does anything, I'll try to let you know!

Oh, it's not too bad--I am convinced there's a magic training program for women instead, and it works a lot better. I've already had more than twenty orgasms today, and that's pretty standard for me. What's more, I wanted to have them, so both performance and libido are up there. Just be careful what you wish for.