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Testosterone Therapy for Treatment of Disorders of Desire
Screening
Baseline testosterone levels** (free and total), baseline lipid profile, baseline liver enzyme levels, mammography, Papanicolaou smear
Initiate therapy
Combination product (Estratest or Estratest hs)
Methyltestosterone (Android), 1.25 to 2.5 mg daily
Micronized oral testosterone, 5 mg twice daily
Testosterone proprionate 2 percent in petroleum applied daily to every other day
Testosterone injectables/pellets
Methyltestosterone (Android), 1.25 to 2.5 mg daily
Micronized oral testosterone, 5 mg twice daily
Testosterone proprionate 2 percent in petroleum applied daily to every other day
Testosterone injectables/pellets
Reevaluation at three to four months
Repeat testosterone levels, lipid profile, liver enzyme levels
Monitor symptoms, side effects
Monitor symptoms, side effects
Continued therapy
Taper to lowest effective dosage
Monitor lipid levels, liver enzyme levels once or twice yearly
Routine Papanicolaou smear and mammography schedules
Monitor lipid levels, liver enzyme levels once or twice yearly
Routine Papanicolaou smear and mammography schedules
These are recommendations; no evidence-based protocols are available on testosterone therapy for the treatment of women with desire disorders.
Many authors recommend that total levels remain in "normal" range for premenopausal women.
None of these medications are labeled by the U.S. Food and Drug Administration for treatment of desire disorders.
Alternate daily combined with estrogen-only pill, take testosterone pill every other day, 5 days a week, etc. (not shown in studies to be safer or have fewer side effects).
Testosterone appears to have a direct role in sexual desire.20 However, because studies evaluate mostly testosterone-deficient, oophorectomized women or women who develop supraphysiologic levels secondary to testosterone treatment, clinical applications are limited. No guidelines for testosterone replacement therapy for women with disorders of desire and no consensus of "normal" or "therapeutic" levels of testosterone therapy exist. Many physicians are concerned about the lack of safety data on the role of testosterone in breast cancer and on hepatic side effects; however, hepatocellular damage or carcinoma is rare at prescribed dosages, 26 and the development of breast cancer has not been reported clinically.27
The side effects of testosterone, which occur in 5 to 35 percent of patients, include lower levels of high-density lipoprotein, acne, hirsutism, clitorimegaly and voice deepening. 27 However, these side effects on lipoprotein levels are rarely significant if estrogen and testosterone are coadministered; moreover, most other side effects are reversible with discontinuation of testosterone or a dosage adjustment.26
A role for testosterone treatment exists in selected patients. Coadministration with estrogen therapy should be provided to prevent deleterious effects on lipoprotein levels. Before initiating testosterone treatment, physicians should discuss the potential and theoretic risks, and individual risk and benefit assessments with the patient. In general, patients with current or previous breast cancer, uncontrolled hyperlipidemia, liver disease, acne or hirsutism should not receive testosterone therapy.
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