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Treatment Options for Vaginal Atrophy:

What Do the Newer Studies Show?

As women enter the menopausal age, hormones start declining, and without therapy, symptoms of menopause become exacerbated. With this hormone loss, the vaginal epithelium becomes atrophic and physiological lubrication is reduced. This can lead to physical discomforts such as vaginal dryness, irritation, itching, burning, dyspareunia, all which can lead to decreased libido, causing sexual distress both to the patient and her partner.

Conventional treatments include intra-vaginal conjugated estrogen or estradiol; however, other studies have provided compounders with alternative choices. Vaginal moisturizers can improve the balance of intracellular fluids in the vaginal epithelium. Vaginal lubricants have more of a short-term action as they act as a mechanical barrier between the vaginal epithelium and the external environment, improving the dryness related to sexual activity.

In 2008, Constantino and Guaraldi published a study that utilized a vaginal suppository containing hyaluronic acid sodium salt 5 mg, vitamin E acetate 1 mg, and vitamin A palmitate 1 mg. Dosing was a suppository intravaginally every night for 14 nights, then tapering to every other night for 14 nights. Of 150 women, 126 women completed the study in full. The study assessed efficacy of the study medication in the areas of burning, itching, dyspareunia, inflammation and irritation. Results showed that any symptom that was reported as severe initially was resolved to either mild or absent at the end of four weeks.¹

Hyaluronic acid helps to form an extracellular water film, which moisturizes the skin, maintaining a water balance aiding in skin elasticity. It also facilitates the healing process and tissue regeneration. Vitamin E, which has antioxidant properties, also acts as an anti-inflammatory and healing agent. Vitamin A has been shown to increase the function of the immune local cells and the epithelium of the vagina.

Chollet et al evaluated the safety and efficacy of a vaginal suppository compound for vaginal atrophy. Estriol 1 mg and progesterone 30 mg was given daily for two weeks, then three times weekly for a total of six months. In a study group of 19 women, results showed improvement in vaginal pH, vaginal dryness, and libido. Follow-up endometrial biopsies were performed, and no hyperplasia or carcinoma were noted at six months of treatment. Serum estriol concentrations were taken at baseline, preinsertion of the dose, five hours post-dose, at week two, and at months three and six. What is interesting to note is that the estriol serum level did not differ statistically from the baseline to preinsertion dose, at week two, or months three or six, suggesting that estriol has minimal systemic accumulation, as reflected in the study.

Serum progesterone levels increased at all time points, with a median serum level that was less at month six when compared at month three. Also, preinsertion serum levels were higher at week two than at month three, indicating that absorption of intravaginal progesterone 30 mg dose during maintenance phase does not gradually increase. Side   effects noted were early vaginal spotting (which resolved, no recurrence), and vulvar and vaginal irritation.²

Although many groups have stated their positions regarding the use of progestin in women with a uterus while taking estrogen, Chollet et al mentions that other studies utilizing unopposed intravaginal estrogen had increased endometrial thickness. While the patient population was small in the estriol and progesterone intravaginal study, it confirms that the medications were well tolerated, and endometrial hyperplasia did not occur at these doses of hormones.² Estriol 1 mg/progesterone 30 mg vaginal suppository formula.

Lastly, dehydroepiandrosterone (DHEA) has been studied for libido and sexual dysfunction in postmenopausal women. Intravaginal doses studied include 3.25 mg, 6.5 mg, and 13 mg versus placebo. A parameter of this study considered the benefit of intravaginal DHEA on vaginal atrophy, dryness, and itching. Results showed that at the end of 12 weeks, all three doses had an equal benefit on vaginal dryness and no adverse events were reported. On the domain of arousal lubrication, the 13 mg dose achieved the best score, although all three doses showed tremendous benefit at 12 weeks.³ Serum steroid levels were evaluated in a separate study and found to be within the normal postmenopausal range.⁴

The Constantino and Guaraldi study provides a non-hormonal treatment for some women, in addition to intra-vaginal Vitamin E. These studies provide great marketing material for some practitioners, and you can obtain them from PUBMED (www.ncbi.nlm.nih.gov/pubmed/) for a fee.

Contact: The Healthy Choice Compounding Pharmacy for more information at: (914) 238-1700

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References:

1.         Constantino D, Guaraldi C. Effectiveness and safety of vaginal suppositories for   the treatment of the vaginal atrophy in postmenopausal women: an open, non-    controlled clinical trial. Eur Rev Med Pharmacol Sci. 2008 Nov-Dec;12(6):411-6.

2.         Chollet JA, Carter G, Meyn LA, Mermelstein F, Balk JL. Efficacy and safety of    vaginal estriol and progesterone in postmenopausal women with atrophic          vaginitis. Menopause. 2009 Sept-Oct;16(5):978-83.

3.         Labrie F, Archer D, et al. Effect of intravaginal dehydroepiandrosterone    (Prasterone) on libido and sexual dysfunction in postmenopausal women.         Menopause. 2009 Sep-Oct;16(5):923-31.

4.         Labrie F, Archer D, et al. Serum steroid levels during 12-week intravaginal             dehydroepiandrosterone administrtion. Menopause. 2009 Sep-Oct;16(5):897-906

Synthetic estrogens are used to make medicine, to fatten animals before slaughter, to get cows to give more milk, to kill bugs on our fruits and vegetables, and to produce industrial plastic and petroleum products. Over-exposure to environmental estrogens affects the balance between estrogen and progesterone – another female hormone. When progesterone levels drop off during menopause, the over-abundance of estrogen caused by the intake of chemical estrogen-like compounds increases the incidence and severity of menopause-related symptoms.

Estrogen dominance can also occur when progesterone production drops. This can occur during periods of high stress, and at any time in a woman’s reproductive life, from the time of her first period, after childbirth and especially during menopause. Estrogen dominance can cause thyroid problems, breast disease or tenderness, heavy or irregular periods, water retention, moodiness, weight gain and insomnia. Treatment can be as easy as adding Progesterone.  Some symptoms of estrogen dominance include:

Mood Swings
Irritation and Nervousness
Headaches
Breast Tenderness
Anxiety
Uterine Fibroids
Water Retention
Fibrocystic Breasts
Feels Cold
Menstrual Bleeding Changes

If you are concerned that  you may be experiencing Menopausal symptoms please click on this Link http://www.thehealthychoice.net/survey.htmand take our Free Hormone Assessment Analysis and within 48 hours we will contact you with your results and our recommendations.

Phil Altman, R.Ph.,

Compounding Pharmacist

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Estrogen is produced in several places in the body, including the ovaries, adrenal glands and fat cells. Even if your ovaries have been removed or you have gone through menopause, estrogen is still being produced in low but measurable amounts by these other tissues. There are multiple steps needed to help ensure safe excretion of estrogen from the body. These steps produce different end products or “metabolites” along the way. There are some metabolites that are “bad” because they are toxic and damage DNA, as opposed to the “good” estrogen metabolites that behave safely and are preferable. Although our genetics influence how easily we make the good and bad estrogens, it turns out (big surprise!) that food and other lifestyle factors have an enormous effect on the kinds of metabolites the liver will make. These are what we focus on for breast cancer prevention at BCH and Nutrition@BlumKitchen.

Genetic and urine testing can also be done to evaluate one’s risk for making bad estrogens. With these test results, we can determine how to use food, supplements and behavior modification to increase good estrogen levels and lower bad ones. For example, foods which support estrogen detoxification pathways include: cruciferous vegetables like kale, broccoli and cauliflower; fiber from fruits and vegetables; soy; dried beans; and ground flax seeds. Let us help you understand what you need by reviewing your personal health history and conducting one of these tests if needed. Or, go directly to Nutrition@BlumKitchen for one of our Cancer Fighting Foods classes. See Chef Marti’s list of breast-cancer-fighting foods below, along with a delicious recipe.

Supplement of the Month

Di-indolylmethane, or DIM, can be taken in supplement form to improve the good:bad estrogen ratio and decrease the risk of breast cancer. We also recommend it to reduce symptoms of too much estrogen. Research supports the use of DIM as a supplement because of its safe activity in the body and low side effect profile. DIM is poorly absorbed into the body unless it is bound to oils and fat-soluble nutrients in the same capsule. We use DIMAvail, made by Designs for Health, due to superior absorption and bioavailability in the body. DIMAvail is 10% off for the month of October.

Blum Center for Health

34 Rye Ridge Road Plaza

Rye Brook, NY  10573

Contact Us: (914) 652-7800

www.blumcenterforhealth.com

The Healthy Choice’s Second Annual BHRT Seminar

Thank you to everyone who attended The Healthy Choice Compounding Pharmacy’s  second annual BHRT Seminar.  This Seminar was for Doctors and Staff interested in learning how to better incorporate Bio Identical Hormone Replacement Therapy into their practice.

This years presenter was Dr. Pamela Smith, MD, MPH, Author of “HRT, The Answers” . 

Dr. Smith  has been featured  on CNN & PBS. 

Click Here to Learn More!

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What Are Bio-Identical Hormones?

Bio-identical hormones are an exact replica of the hormones that are naturally produced by the body.  They match your body’s hormones molecule by molecule. They are natural hormones because they are made from soy, yams and other plant extracts. They are termed “bio-identical” because they are compounded to match each individual patient.

What Is The Difference Between Bio-Identical Hormones and Synthetic Hormones?

The difference between bio-identical hormones and synthetic hormones is that, although both are created in labs, synthetic hormones are not identical to the hormones naturally created in your body, whereas bio-identical hormones match your body’s hormones molecule by molecule.
Synthetic hormones are derived from plant progesterone and animal estrogens, but are not identical to the hormones your body uses. Synthetic hormones act as toxins because their chemical makeup cannot be metabolized properly. Premarin is a non-bio-identical hormone which is obtained from the urine of pregnant horses. Provera is also an example of a synthetic hormone. It causes bone loss or osteoporosis. Their combination called Prempro has been marked with a black-box warning for causing serious health risks.
Bio-identical hormones or natural hormones are replicas of the body’s own natural hormones. Bio-identical hormones are made from soy, yams and other plant extracts. Then they are sent to the compounding pharmacy and made to match each individuals needs.

Do I Need A Prescription?

Yes, bio-identical hormones are compounded prescription medications that we produce in our specialized pharmacy.  Each prescription is made with only the highest quality ingredients and made to fit each patients individualized need.

Can You Recommend A Physician That Prescribes It?

Yes, we have a large list of participating doctors.  These doctors are highly trained and comfortable working with bio-identical hormones.  They will work closely with you, and Phil Altman, your Compounding Pharmacist.  They will customize a BHRT regimen designed especially for you.

What Are My Options?

First of all, you have to decide if you are a candidate for hormone replacement therapy, not everyone is. This is a personal choice, it is a choice that you must be educated in. Because in order to have a successful experience you have to be an active participant.

Not everyone is a candidate for estrogen, they might just need some progesterone and/or testosterone, DHEA, Pregnelone etc.. Once you decide what forms of hormones you might need restoration in, then you must decide what dosage form to use. Do you want to use a cream ,capsule or drops etc.. These are all of the basic questions that you must ask yourself, your practitioner and compounding pharmacist.  Everyone must be on the same page. Your options are as varied as there are different people. EXPLORE THEM

Are They Safe?

Everyone is concerned about safety as they should be. We feel that bio-identical hormones give you the best risk reward ratio. We feel that when ever you take any form of estrogen there is some risk involved. But bio-identical hormones, since they are structurally identical to what your body produces, they get excreted very quickly. Progesterone vs. progestins is also very important.  Progesterone opposes estrogen throughout your entire body, not just your uterus. Progesterone will also increase cell death while progestins do not. Progesterone acts as a natural diuretic to help prevent weight gain.
Estriol is the weakest of all the estrogens and has the most cancer protecting properties. Just another reason why bio-identical hormones are safer than commercially available products. Even when estriol E3 is combined with estradiol E2 the estriol will help reduce the negative benefit of estradiol.

PROGESTERONE BENEFITS
Opposes estrogen thru out your entire body
Acts as a natural diuretic
Acts as a mood elevator
Helps balance thyroid
Helps balance blood sugar
Helps build bones

When Will I Feel Better?

Everyone is different, everyone’s stress level is different, as well as there preexisting hormone level.
If you could look around a room and tell me which two people are the same then, I can tell you exactly  when it will work. People’s lifestyles all vary. You are what you eat! Are you a big meat eater or a vegan?  Are you overweight?? Estrogen is stored in fat cells.  Overweight people will release more estrogen into there system therefore, they may not need estrogen replacement therapy.

Stress also plays a large part of when you feel better.  It‘s all about balance. Balancing your hormones, lifestyle, stress etc.. The quicker you can put all of that in balance the quicker you are going to feel better.

What Forms Does It Come In?  What Dosage Form Is Best For Me?

One of the keys to bio-identical hormone replacement therapy, is the different dosage  forms it can come in. We have the ability to customize dosage forms to fit each individual patient. Using a compounding pharmacist to help you decide what dosage form to use, will be key in having a successful therapy. If you have any digestive disorders we strongly  recommend using the transdermal route. Although, the American preference has usually been to take a pill over using creams.   If you decide to go the transdermal route, there are different delivery systems, i.e. syringes, pumps, jars etc.. There are also different bases that we can use depending on  the sensitivity level of the patient. Also, when you use the transdermal route you have more dosing flexibility.  You can take 1 & 1/2 doses of a cream, whereas it’s more difficult to take 1 & 1/2 capsules. There are also lozenges you can suck on, vaginal suppositories, vaginal creams, drops etc.. The key with dosing is finding out what is going to work best for the individual patient.

How Do These Products Work?

There is a lot of misinformation about this. Physicians, as well as patients, do not always understand the structure function statement. That, if you change any part of the chemical structure of any chemical, you will change the function of that product. So what that means, is that these Bio-Identical Hormones are structurally identical to what your body produces. This is more of hormone restoration. Replacing hormones (structurally identical) to what your body is no longer producing. It is like tricking your body into thinking you are producing more hormones, thus putting  you in a pre peri-menopausal phase. The goal of these products is to put you back in balance!

Will I Gain Weight?

Hormones are chemical messages that cause the body to make changes affecting weight gain or weight loss.  When your hormones are out of balance, it can, in some cases, makes it easier to gain weight and harder to lose weight.  When your hormones are in balance you get the most out of your nutrition therefore, making it easier to lose weight.  For instance, men as they get older get less active and have a decline in testosterone.  This particular hormone boosts  metabolism which helps lower body fat. Concluding, that when testosterone levels are balanced  a man’s ideal weight is easier to achieve.

Do I Need To Take These Hormones Forever?

Not necessarily, it depends on how well your body responds to bio-identical hormone therapy. Also important, it’s how well you manage your diet, sleep patterns, exercise, and stress levels that will assist you in regaining hormonal balance. Some patients can wean off various hormones once they become balanced and have fewer symptoms of menopause or andropause. There are also patients who can wean off adrenal and thyroid support once their adrenals or thyroid glands have healed. There is no single answer for everyone, it depends on your individual hormone stability and how well your diet and lifestyle will support everything else. In the worst-case scenario, if you decided to stop bio-identical hormone therapy, your body would return to the state it was in before initiating your program.

What Is The Women’s Health Initiative?

The National Institutes of Health (NIH) established the Women’s Health Initiative (WHI) in 1991 to address the most common causes of death, disability and impaired quality of life in postmenopausal women. The Women’s Health Initiative was designed to define the risks and benefits of using synthetic hormone therapy to potentially prevent heart disease, breast and colorectal cancer, and osteoporosis in postmenopausal women.
It is important to note that the women in this study were all postmenopausal, average age of sixty-eight. This fact is significant as most of these women had 15 years since the loss of their hormones to develop diseases that estrogen, progesterone, and testosterone might have prevented. Most importantly, the study used synthetic hormones and not natural bio-identical hormones. This was a 15 year research program and the women in these studies are now participating in a follow-up phase, which will last until 2010.

Why Is There So Much Confusion About Bio-Identical Hormones?

Bio-identical hormone preparations are medications that contain hormones that are an exact chemical match to those made naturally by humans. Some bio-identical hormones are made by drug companies, are approved by the FDA, and are sold in standard doses. Other bio-identical hormone preparations are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. Those “custom-made” preparations aren’t approved by the FDA. The FDA doesn’t approve any compounded products, for any condition, because those products aren’t standardized. But, the purpose of compounding is to do it on a patient-by-patient basis, so there’s nothing that’s submitted to the FDA to evaluate, so they’re not FDA approved. And because compounded products don’t go through the FDA approval process, they don’t bear the same warnings as other hormone therapy. A woman who gets a prescription for an FDA-approved hormone therapy for menopausal symptoms is “going to get a lot of warning information,” but if she gets a compounded product instead, “you don’t get any of those warnings. There’s no requirement for them to provide that because those products are not FDA approved.”

How To Know If Bio-identical Hormones Are Right For Me?

Some women just know when they are not feeling “quite right” or “like they used to”.  To help answer this question, ask yourself:
Do I have hot flashes?
Can I not sleep at night?
Do you wake at night sweating excessively?
Is your menstrual cycle more irregular than when you were in your twenties and thirties?
Do you have alterations of heavier bleeding one cycle and lighter the next?
Do you have difficulty concentrating?
Do you have mind fog?
Do you feel more anxious now, and for no reason?
Do you have vaginal dryness or painful intercourse?
Are you more depressed?
Have lack of energy?
Depending on how many questions you’ve answered yes to will let you know if you should consider BHRT.  But, we are all individuals and someone who just has one of these problems might find it bothersome enough to seek out help.  You don’t have to feel this way, just because you are getting older.  You can do something about it.

Phil Altman, R.Ph., Compounding Pharmacist
(914) 238-1700
Email:Phil@TheHealthyChoice.net

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Testosterone in Men and Women
While it is well known that a surge in testosterone production in the testes of boys brings about the changes that lead to manhood, it is not well known that women also produce testosterone (albeit at about one-tenth the level as men) in their ovaries and adrenal glands. As in men, levels of testosterone peak in women in their twenties and decline thereafter. Like men, women not only experience a decline in testosterone production, but also in hormones such as dehydroepiandrosterone (DHEA), which falls dramatically for women after menopause. Although doctors have known that women produce testosterone, most mainstream physicians have believed that hormones like testosterone are not important for women. Only levels of the “female” hormones progesterone and estrogen were thought to have any significant bearing on a woman’s health and well being. Over the last decade, however, more and more evidence has been brought forth suggesting that testosterone is a very important hormone for women, especially in terms of staying fit, lean, and sexually active. One of the most widely disseminated studies showing testosterone’s importance in maintaining a woman’s general well being and sexual functioning was published in 2000 in the New England
Journal of Medicine.1 This randomized, double-blind, placebo-controlled study examined the effects of transdermal testosterone patches on 75 women aged 31 to 56 years who had undergone a hysterectomy and bilateral oophorectomy (removal of both ovaries). Hysterectomies, with or without an oophorectomy, significantly decrease circulating levels of testosterone. Over three consecutive 12-week periods, the women were given placebo, 150-mcg testosterone patches, or 300-mcg testosterone patches. The un-equivocal result was that women who received 300-mcg patches showed significant improvement in sexual function, mood, and general well being.

Effects on Strength and Fitness
Besides its psychological and sexual effects, adequate levels of testosterone play an important role in helping women maintain a healthy body composition. While it is known that women begin to gain body fat 10 years before they experience menopause, and that many women gain weight when taking birth control pills, doctors often overlook the role that testosterone can play in helping to ameliorate this weight gain. This is likely because most doctors are uninformed about the use of testosterone replacement therapy in women. In addition, some early studies, now viewed as flawed, linked elevated testosterone levels in women with abdominal obesity (the patients involved had multiple hormonal imbalances that certainly contributed to their obesity). More recent scientific studies, such as one reported in the Journal of Clinical Endocrinology and Metabolism, have shown that obese women given low doses of synthetic analogues of testosterone (nandrolone) lost more body fat and subcutaneous abdominal fat, and gained more muscle mass, than women given a placebo.5 The study participants followed a low-calorie diet but did not change their exercise habits; after nine months, those women taking nandrolone had lost twice the body fat and gained six pounds of lean muscle mass compared to women in the placebo group.

Deficiencies May Lead to Heart Disease
Besides helping women maintain lean muscle mass and an enjoyable sex life well into their forties, fifties, and sixties, new evidence points to additional positive effects of testosterone on a woman’s health as she ages. An intriguing report in the Journal of Women’s Health examined the hypothesis that testosterone deficiency is a key predictive factor for heart disease in aging women or women who have had hysterectomies.6 Cardiovascular disease is the leading cause of death in postmenopausal women. Women who have hysterectomies are three times more likely to develop cardiovascular disease compared to women who have not had one. Women who have hysterectomies generally receive estrogen replacement therapy but not testosterone replacement. The study author postulates that this treatment discrepancy is why the incidence of heart disease rises dramatically in these women, and concludes that “the data we have demonstrating cardioprotective effects of testosterone, together with what we know about the loss of testosterone production in both instances of oophorectomy with hysterectomy and in women whose remaining ovarian function has been compromised by hysterectomy, point to testosterone deficiency as a significant factor to the reported increased incidence of cardiovascular risk factors [in women].”

Does Testosterone Inhibit Breast Cancer?
The words “breast cancer” can produce an involuntary shudder in most women, and for good reason: breast cancer is the most common cancer in women, and despite billions of dollars spent on research and treatment since the 1970s, it has been steadily increasing in incidence. It is estimated that in 2004, approximately 300,000 American women will be diagnosed with breast cancer and approximately 46,000 will die from the disease. Many researchers believe that high estrogen levels are a major risk factor for developing breast cancer, and some have postulated that high testosterone levels in women also may pose an increased risk for breast cancer.7 On the other hand, other researchers believe the association between high testosterone levels and breast cancer in some limited studies may reflect that testosterone and estrogen levels are highly correlated in women, as testosterone can be a precursor for estrogen synthesis. Multiple studies now show that testosterone may help guard women against breast cancer. A study in 2000 looked at the effects of testosterone and tamoxifen (a widely used chemotherapeutic agent for breast cancer) on breast cell stimulation.8 The study showed that breast cells exposed to estrogen showed cancer-like rapid growth, but showed significantly less growth when also exposed to testosterone. A more recent study published in 2003 also showed that testosterone significantly inhibits breast cell growth, leading the authors to conclude that “ …androgens [testosterone] may protect against breast cancer, by analogy with P4 [progesterone] effects upon the uterus.”9

Ways to Increase Testosterone Naturally
Many women are still leery of hormonal supplements such as testosterone. Others do not have the luxury of having a physician who is well versed in integrative therapies. Most mainstream physicians still cling to the idea that testosterone is a man’s hormone and supplementing with it has no place in women’s health, even with the abundance of scientific evidence showing otherwise. The good news is that there are some proven, natural ways a woman can safely increase her testosterone levels to maintain optimal health into her forties, fifties, sixties, and beyond. Multiple studies have shown that resistance exercise can increase men’s testosterone levels. Some lesser-known but equally impressive studies show that exercise likewise can increase women’s testosterone levels, whether they are 20 or 60 years old. A study in 2001 examined the acute effects of resistance exercise in 47 women aged 19 to 25.10 After just six sets of repetitive motion squat exercises, significant increases were noted in both free and total testosterone levels. A study in 2002 examined the effects of endurance and resistance exercise on hormonal levels, including testosterone, in women 19-69 years of age.11 As in the previous study, testosterone levels increased significantly in women who did either endurance or resistance exercises, regardless of their age. Another study conducted in 2003, which examined the hormonal effects of high-impact physical exercise in 25 early postmenopausal women aged 53-59, showed a significant and acute rise in testosterone levels following exercise.12 Like testosterone, DHEA is a hormone that has long been recognized by holistic practitioners as essential for optimal health in women and men. DHEA is secreted into the bloodstream by the adrenals in humans and other primates, and then converted into DHEA sulfate (DHEA-S). Since DHEA’s discovery, hundreds of scientific articles have been published on its wide-ranging effects. DHEA is a precursor to testosterone and estrogen. As with testosterone, DHEA levels peak in women in their twenties and then slowly but steadily decline, dropping by about 10% every decade of life. Some intriguing early studies have correlated the decline in DHEA production with many of the degenerative changes seen in aging in women and men, such as heart disease, cancer, and osteoporosis.13 While it is considered physiologically “normal” for DHEA to decline during aging, under certain conditions DHEA levels plummet early in life. Addison’s disease, or primary adrenal failure,occurs in about 1 in every 25,000 people. Without functioning adrenal glands, the body cannot produce many important steroid hormones, including DHEA. Standard treatment for this condition has been to replace the missing hormones. Until very recently, however, most mainstream physicians did not replace DHEA. Furthermore, patients with Addison’s disease, even those who received standard hormone replacement therapy, consistently report a reduced quality of life with symptoms such as persistent fatigue and depression. A recent study looked at the effects of DHEA supplementation in patients with Addison’s disease.13 In this randomized, double-blind trial, 39 patients (24 women and 15 men, aged 25-69) were given either 50 mg of DHEA daily for 12 weeks, followed by a four-week washout period, then 12 weeks of placebo, or vice versa. After DHEA supplementation, blood levels of DHEA rose from subnormal (as would be expected in Addison’s disease) to the normal range for young adults. More important, both the women and men taking DHEA showed significant positive psychological changes, including enhancements in self-esteem and mood and a decrease in fatigue. Besides Addison’s disease, other conditions cause a significant decrease in DHEA levels. Adrenal insufficiency is a condition in which the adrenal glands secrete some hormones, but not at normal levels. In a double-blind study of 24 women with adrenal insufficiency, DHEA supplementation (50 mg daily for four months) raised DHEA-S levels to normal.14 It also increased the women’s sense of well being and frequency of sexual thoughts and interest, as well as decreased depression and anxiety.

DHEA Delays Aging’s Physical Effects
Because DHEA is at high levels in young adults and then declines precipitously thereafter, there has been great interest in using DHEA as an anti-aging hormone. One of the most widely touted studies that examine DHEA supplementation to counteract the effects of aging was done by researchers at the University of California School of Medicine.15 This randomized, double-blind, placebo-controlled trial followed 17 women and 13 men, aged 40-70 years, over a six-month period. For three months, they were given 50 mg per day of DHEA, then three months of placebo at bedtime in random order. Within two weeks of starting DHEA, the patients had attained DHEA blood levels of young adults. After three months on DHEA, 82% of the women and 67% of the men reported an increased sense of well being, which included improved quality of sleep, less anxiety, increased energy, and improved ability to handle stress. DHEA and Optimizing Testosterone Because DHEA is a precursor hormone for testosterone, it makes sense to think that DHEA
supplementation could safely and effectively raise testosterone to optimal levels in women of all ages. A 1998 study examined the effects of short-term treatment of 100 mg per day of DHEA on postmenopausal women aged 52-56.16 This study showed that after only seven days of supplementation, testosterone levels were significantly increased. Another study, this one a randomized, placebo-controlled trial on 60 perimenopausal women aged 45-55, also examined the effects of DHEA supplementation (50 mg per day) on testosterone and other hormone levels over a three-month period.17 Again, women who took DHEA supplements had significantly higher testosterone levels than women who were in the placebo group. Finally, a study was done that examined the hormonal effects of DHEA (50 mg per day) on 31 women, aged 50-65 years, over a six-month period.18 Like the previously cited studies, women who took DHEA had higher levels of testosterone as well as other “beneficial” hormones such as growth hormone, which led the authors of the study to conclude that “DHEA is more than a simple diet supplement or anti-aging product; rather, it should be considered an effective hormonal replacement treatment.”

DHEA and Sexual Function
In both pre- and postmenopausal women, DHEA supplementation has been shown in multiple studies to have a positive effect on sexual functioning. A randomized, double-blind, placebo controlled study published in 1999 examined the effects of 50 mg per day of DHEA in 280 women and men aged 60-79 years.19 When compared to women taking placebo, the women taking DHEA reported statistically significant improvements in libido, sexual activity, and overall sexual satisfaction. A more recent study published in 2002 in the Journal of Sex and Marital Therapy examined the effects of 50 mg per day of DHEA on 111 pre-menopausal women aged 35-55 years over a period of two to six months.20 As in previous studies, in this study women taking DHEA supplements reported significant improvements in sexual function in terms of desire, arousal, lubrication, satisfaction, and orgasm. Slowly and begrudgingly, mainstream medicine is beginning to realize that those who believe in the power of integrative medicine may be on to something very important. As more studies show that supplements like DHEA and hormones such as testosterone can help women maintain their zest for life (and for sex) throughout their lives, it is only a matter of time until all women, whether or not they have a physician who is well versed in integrative medicine, will be able to receive the medical care and guidance they deserve to live long and healthy lives.

References
1. Shifren JL, Braunstein GD, Simon JA, et al. Transdermal testosterone treatment in women with impaired sexual functioningafter oophorectomy. N Engl J Med. 2000 Sep 7;343(10):682-8.
2. Davis S. Androgen replacement in women: a commentary. J Clin Endocrinol Metab. 1999 Jun;84(6):1886-91.
3. Davis SR. Androgens and female sexuality. J Gend Specif Med. 2000 Jan-Feb;3(1):36-40.
4. Davis SR, McCloud P, Strauss BJ, Burger H. Testosterone enhances estradiol’s effects on postmenopausal bone density and
sexuality. Maturitas. 1995 Apr;21(3):227-36.
5. Lovejoy JC, Bray GA, Bourgeois MO, et al. Exogenous androgens influence body com- position and regional body fat
distribution in obese postmenopausal women—a clinical research center study. J Clin Endocrinol Metab. 1996 Jun;81(6):2198-
203.
6. Rako S. Testosterone deficiency: a key factor in the increased cardiovascular risk to women following hysterectomy or with natural aging? J Womens Health. 1998 Sep;7(7):825-9.
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