Part 7: Free Testosterone

I just returned from a conference of The International Society for the Study of Women's Sexual Health (ISSWSH). One of the topics that will received lots of "air time" is testosterone levels and supplementation in women. And, so it should.

It's been pretty amazing to me that testosterone is so misunderstood by consumers and by medical professionals. I wish that I had a dollar for every time I've heard a female client who had inquired about testosterone tell me that her medical care professional had commented, "Do you want to grow a beard?" or "Your voice will deepen" or "You'll get acne."

The masculinization effects of testosterone supplementation are grossly overestimated when it is properly used (which is about one-tenth of a male dose). I have seen many women successfully supplement their testosterone levels and restore their sexual interest. But to do it well, it's important to get the right measurements.

Total testosterone (the blood test more commonly authorized) tells how much testosterone is in the bloodstream all together. Some of that testosterone is bound to molecules such as SHBG (sex hormone binding globuline). When it's bound, it does not create a physiologic sense of sexual desire. So, we want to know about the free testosterone instead.

Free testosterone is just that -- free. It is not bound and therefore does provide some of the momentum for sexual desire based on hormones. So, knowing the free testosterone can lead the way to assessing the possible benefit of supplementing with testosterone. Merely giving a woman some testosterone and seeing how she does without blood tests is not good science.

But there's a problem with measuring free testosterone. Most labs do not use equilibrium dialysis, the "gold standard" method for measuring it. So, there's another way to get a very accurate assessment of a woman's free testosterone.

Here it is. Do two blood tests: the total testosterone and the SHBG (sex hormone binding globulin). Then run those numbers through the free testosterone calculator here. The normal calculated free testosterone is 0.4 - 0.8 ng/dl (or 40 - 80 pg/dl). If a woman is low, she can consider supplementing.

Transdermal methods currently are deemed the best method for supplementing. So, gels can be prescribed at a one-tenth male dose as a good starting point. They can be applied to the hips and calves "Macarena style."

It is likely that once the trepidation about masculinizing women subsides, the FDA will allow the testosterone patch to receive approval. In May 2006, the European Medicines Agency, a European organization that is their equivalent of our FDA, just approved the testosterone patch made by Proctor and Gamble (the same one that had been heading to the U.S. market last year before a case of the nerves set in).

It's important to remember that a testosterone gel or patch will not solve all aspects of a woman's lack of sexual interest -- far from it! (That's why there were nine other reasons on this list!) But, a woman who once had adequately high testosterone and then experiences a change (for reasons that we are still exploring), may very well find testosterone supplementation to be exactly what she needs. And, women who may have had low free testosterone throughout their lives, might get a chance to learn what all the fuss is about.

Related Topics: Menopause and Perimenopause: Medications, Less Sexual Desire After the Pill?

Technorati Tags: sexuality, women's health, testosterone

My Most Unusual Reconnection with a Childhood Friend

Pubic hair. I never thought that I would hear from a friend I met in elementary school over that topic, but yesterday I did. I love my job.

I have not had contact with my friend, Jerry, since the 20th reunion of my high school class -- fifteen years ago. But, out of the blue she called my office and left me a message. What brought me to her mind? Shaving her pubic hair.

It seems that she's currently in a new relationship (after a divorce) and her partner mentioned that he found it sexually attractive when women trimmed or shaved their pubic hair. She said, "That sounds interesting to me." So, being the ever-thorough student that she always was in school, she used a search engine to learn the ins and outs of coiffing her nether parts.

What popped up? An article written by my colleague, Michael Castleman, about the phenomenon of shaving. In it, he asked me how the porn stars got it to look the way that they did and I replied with a sigh, "... I wish I knew." The rest of the article consisted of lots of tips that he accumulated in interviewing various "experts" on the topic.

So, after gathering all the tips, Jerry called and left a cryptic message about being a "voice from the past" and that I'd never guess how she came across my name. Since my presence on the Internet is ample, I suspected that her call was linked to something I had written somewhere. Yet, I should have guessed. When I wrote a piece about this topic several years ago, it caused a lot of comment -- much more than I would have anticipated. And here it was again.

I have interviewed gynecologists and their nurse practitioners about the prevalence of this phenomenon. I've found from this casual "research" that as a woman's age increases, the likelihood of pubic hair shaving decreases. So, perhaps that is a clue about women in new relationships after divorce. They are trying to feel and be young again.

Meanwhile, hearing from someone that I met over forty years ago only made me feel "mature." But what fun it was to reminisce with stories about Girl Scouts, an April Fool's joke we played on our math teacher, and clever word play about a teacher we had who got married and divorced in a short time period. There were also some poignant moments as we talked about classmates who had died from breast cancer and suicide. The conversation flowed like it had been a few weeks since we last talked.

Like I said, I love my job.

Related Topics: Sexuality and Physical Changes with Age, A Woman's View of ED

Technorati Tags: sexuality, middle age, divorce recovery, reunion

Part 5: Stress

This is the fifth in a series of "Ten Reasons Why Women May Lack Sexual Desire."

One of the most commonly held ideas about sex is that it's a great stress reliever. And, it is. But stress can also be a libido killer. It all depends on the viewpoint of the person who is stressed.

Men will often say to one another, "Man, you look stressed. You should get laid." While this isn't always the answer to stress for men, you will almost never hear one woman say to another, "Dear, you really are looking stressed. I think that you should go have sex." It just generally isn't the way that most women view stress reduction -- not that having sex can't work that way.

When women are overloaded and overwhelmed, they quite often can't even get started sexually. Touch can feel annoying. The idea of putting out more energy to please someone else feels a really uninviting choice. And, as many women know, having an orgasm often works like an emotional truth serum that reveals despair just when you've managed to get through an entire grueling day without crying over it.

Many women just don't want to go there. That's because if the sex is intimate and functional, they are faced with the combined task of mustering more energy and doing so in close proximity to someone who may have a relevant connection to the stress. And, if her partner is generating the stress -- thanks, but, "no thanks" is the frequent response to, "How about having sex, dear?"

When stress is present, the best option to consider is talking. There's something quite curative for most women in conversation. Discussing the matters decreases the charge and unwinds the tension. Then, maybe a bit later, sex might seem like an acceptable follow up.

Related Topics: Get Sexual for Ultimate Weight Loss, Workplace Stress and Your Health

Technorati Tags: stress, sexual health, relationships, top ten list

Correlation Between Sexual Images Online and Rape

Official figures show a plunge in the number of attempted and completed rapes per capita in the United States since the 1970s. So, our country has become a safer place for women. Is it more police? No. More self-defense classes for women? No. More rapists already in prison? No. What then? More sexually explicit images online? Yes, Internet pornography just may deserve the credit.

A Northwestern University Law Professor, Anthony D'Amato, published a paper this year titled "Porn Up, Rape Down" and offers the numbers to make his case (based on the National Crime Victimization Survey). The incidence of rape has declined by 85 percent in the last 25 years. And though the Nixon and Reagan Commissions tried to show that exposure to sexually explicit materials generated social violence, the reverse may be true.

Men have probably always sought out sexual images. The delivery forms have varied: theatre movies, magazines, videos, and eventually DVDs. But as D'Amato characterizes it, "a seismic change" occurred in the early 1980s. Sexual images became available on the Internet.

Nationwide trends offer interesting data, but when D'Amato analyzed the states, the results were fascinating. In 2001, the states with the lowest per capita access to the Internet were: Arkansas, Kentucky, Minnesota, and West Virginia. The states with the highest per capita access to the Internet were: Alaska, Colorado, New Jersey, and Washington.

He then looked at the police reports for forcible rape for the years 1980 and 2000. While the nationwide incidence of rape was showing a drastic decline, the four states with the least access to the Internet showed an increase in rape during the same time period.

D'Amato then compiled the statistics for the four states with the most access to the Internet. Three of the four states showed a decline (with New Jersey showing an almost 50% decline!). Alaska was the exception, and D'Amato noted that it had the lowest population (about one-tenth of the other states). So, D'Amato combined the populations of the four states with the highest Internet access and the four with the lowest Internet access. He found the high Internet access states had a decrease in rape of 27%. And, the low access states had an increase of 53% in rape.

Professor D'Amato suggests there are two predominant reasons why an increase in the availability of pornography has led to a reduction in rape. First, sexually explicit images provide an easy avenue for the sexually desirous to "get it out of their system." Second, he describes the "Victorian effect." This dates back to the Victorian era where people covered up their bodies with much clothing, generating a greater mystery as to what they looked like naked. D'Amato suggests that the free availability of pornography since the 1970s and the recent barrage of Internet pornography may have de-mystified sex.

I do not know if these are the precise reasons for such a dramatic drop in rape, but this is a very strong correlation. The idea that a social ill such as rape could be close to "cured" (a tribute easily made to a drug that eradicated 85% of a disease) by making sexual images so democratically available is a delight to me. While I personally find some pornography "artless," if it helps a rapist "get it out of his system," I couldn't be happier.

Related Topics: Cyber Straying: Is Online Sex Cheating?, How to Protect Yourself Against Crime

Technorati Tags: Internet Pornography, decline in rape, sexual crimes, sexual health

Part 4: Lack of Sleep

This is the fourth in a series of ten very common reasons why women may find themselves feeling low level of interest in being sexual: Not getting enough sleep.

I sometimes hear,"My partner doesn't want sex because she's too tired. How could anyone be too tired to have sex?" I'll then reply, "Would you rather skip it all together on a given occasion? Or would you rather she fell asleep while you were busily attempting to please her and yourself?" (This does happen.)

This vivid picture of a woman sleeping through sexual acts is often enough to stop her partner from dismissing her fatigue. Some women offer tiredness as an excuse to avoid sex, but there are many women who truly are too tired to go through with it.

Probably the most common cause of lack of sleep among women involves tending to children. It's often the newborn that needs to be fed every three to four hours around the clock. It may be the child who has a hard time falling asleep, staying asleep, or has frequent nightmares. Since women still do the lion's share of childcare, these night time issues with children do tend to affect their sleep most often.

Some women don't sleep well because they're troubled by their relationship. They may not feel comfortable lying next to their mate. They may be sleeping on the couch -- or their mate may be (which causes its own type of discomfort).

And, there are environmental issues -- noisy trains rolling by, a dog outside barking, freeway noises, busy streets and bus lines the roar by, the neighbors arguing in the next apartment, and a snoring bed partner. Some women just can't ignore these noises and they lose sleep over it.

Early on in a relationship, many folks will go without sleep for the sake of the sexual relationship. But, when the bloom is off the rose and the shortcomings and flaws of both partners begin to emerge, sleep can seem a much better use of time.

Sometimes younger people (teens, twenties, thirties) can see the value in losing sleep for the sake of sex too -- even when the relationship has progressed beyond the initial glow. But, even so, a sleepy sex partner isn't always the most enticing.

I recommend that if there is a way to help the sleep-deprived woman get some extra zzz's, the partner seeking the more frequent sex should consider all the ways that could make that happen. Simply complaining about sex deprivation does not count as one of the ways.

Related Topics: Sex Drive May Be Swayed By Genetics, How to Sleep Like An Olympic Athlete

Technorati Tags: sleep deprivation, relationships, sexual health, top ten list

What Foley and Roberts have in common

Two events have dominated the news this week: Representative Mark Foley's apparently sexually explicit messages to Washington pages and Charles Carl Roberts IV's killing of five female school children in Nickel Mines, PA.

It seems that Roberts may have had intentions of sexual assault when he carried out his planned invasion of the Amish schoolhouse. Among the ample supplies he brought was lubricating jelly. It's a strong hint.

Shortly before he shot himself, Roberts told his wife on a cell phone call that he'd had recurring thoughts about sexual exploitations of two girls (ages approximately four and five) that he carried out approximately twenty years ago when he was about twelve.

Mark Foley, a 52-year old male who is presumed to be gay, apparently was reaching out to the pages in what at first glance seemed simple friendly gestures in a power-brokered world where they were at the bottom of the totem pole. Who would turn down pizza at their dorm? But, it seems that once the pages completed their junior-year program and were returning home, Foley attempted to contact some of the male pages that "caught his eye" and whom he hoped were also sexually attracted to him.

What do these two news stories have in common? Two main things. Both have distorted sexuality at their core. And both men could have benefited immensely by having unfettered access to sex therapy.

If the news stories are accurate, Foley has been attracted to males (no problem with that) who are more than thirty years younger (no problem with that either). Before you start clicking the "comment" box, hear me out. Can the heterosexual representatives to Congress claim that they were never attracted to the female pages that grace their hallways? I doubt it.

The problem is that Foley may have acted on those attractions in ways that are exploitive and potentially coercive. It's a matter of boundaries and respect for those boundaries. If Foley had attractions to nubile males, he should have stuck to the twenty-somethings who look younger than they actually are. Our culture considers them adults -- even if they don't always act like it.

I would venture to guess that most gay men are very upset and discouraged by yet another larger than life portrayal of gay men as predators upon our youth. If the allegations prove true, Foley will need intensive sex therapy to work through his compelling sexual preoccupation with teenage males.

If Roberts' final communications with his wife are substantiated (the alleged victims of his sexual exploitation have yet to speak publicly), then this becomes another horribly painful example of a vandalized sexual map. While sexual play as children is quite common and not in itself necessarily a damaging experience, when the sexual interaction occurs between children with seven years difference in age, it's a problem and should be addressed as one.

But the real problem is, most likely no one addressed it. Some news coverage sources doubt it happened because no one seems to have known about it. Is that the epitome of naivete? Because no one knew about it, it didn't happen? Many incarcerated sex offenders can tell tales of the ones that no one knew about.

Why might this be happening? Our culture has had so many ways to repress the reporting of sexual exploitation. And, similarly -- too few ways to treat both the offender and the exploited person. I actually place both of these problems at the feet of a sex-negative culture that is at the same time highly titillated by all things sexual.

Our culture desperately needs to relax about the process of sexual learning and, simultaneously, address it much more directly. We do not need more sex experts. We need wider circles of every day adults available for open dialogue about sexual matters with our children.

Perhaps if Roberts had access to such an adult when he was a child, he would not have cooked up his plan of sexual assault and terror. And, perhaps if Foley had access to open dialogue about his sexuality forty years ago, he would not have become fixated on teenage boys -- boys who should now have the benefit of sex therapy in order to come to grips with their own sexual identity and hopefully avoid the distorted sexuality of their admirer.

Related Topics: How to Protect Yourself Against Crime, 10 Ways to Spot a Liar

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