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Friday, October 19, 2007

Does Testosterone Supplementation Suppress Its Natural Production in Women?

This week I had a clarifying conversation with a colleague, Irwin Goldstein, M.D., who is the Editor-in-Chief of The Journal of Sexual Medicine. I had been under the impression that women who supplemented testosterone through transdermal methods (through the skin) ran the risk of turning off their body’s own ability to produce testosterone from their ovaries and adrenal glands. Happily, this isn’t the case.

When it comes to testosterone supplementation for women, the female clients that I’ve had in my therapy practice have fallen into two general groups:

  1. Women in their twenties and thirties
  2. Women in their forties and fifties.

The latter group has little hesitation to bring on board a medication that they would want to utilize much of the rest of their lives. They are already involved in this process for other body parts and purposes. But, the younger group rightfully has looked at this with some trepidation. That’s because it’s quite often true that when a substance is added to the body to increase the body’s supply of that substance, the body slows down its own manufacturing of that substance.

And, it turns out to be true for men. Here’s how:

When men have low testosterone levels, they are often in their fifth decade or beyond. Supplementing at that point becomes a daily task for as long as the man wishes to have a libido that springs from his body, rather than from his mind – or in addition to it. In order to get male testosterone up to a healthy level, men use quite a bit (for example, a full tube of Testim containing 50 mg every day).

Women do not need the same amount of supplementation in order to have an adequate libido. (They typically use one-tenth of a tube of Testim per day or even a bit less than that.) So, as it turns out, the small amount of testosterone that is needed for women does not shut off their own production from their adrenal glands and their ovaries. It just adds on.

This turns out to be good news for women. In a few years, our FDA will probably see the wisdom of approving testosterone products specifically designed for women. But in the meantime, off-label use of a product like Testim and other testosterone that is compounded for women, will go on.

And, women – both young and old – can participate in this part of a sexual revolution. For half of these women, it’s the second time they’ve been involved in such a cultural shift. Unfortunately, the birth control pill which elevates sex hormone binding globulin (SHBG) that was at the center of the first revolution may very well have been a primary cause of the low levels of testosterone that are at the heart of the current one.

Related Topics:

Technorati Tags: testosterone, women, libido, sexual health

Posted by: WebMD Blogs at 7:57 am

Monday, October 8, 2007

Folsom Street Fair Folly

What Possessed These Parents to Expose Their Kids to This?

I remember when Hugh Grant appeared on “The Tonight Show with Jay Leno” shortly after his arrest while with a street-walking sex worker in L.A. Right off the bat, Jay leaned over and said, “Hugh, I gotta ask…What were you thinkin’?”

That’s what I would like to ask fathers Gary Beuschel and John Kruse when they decided to take their two-year old daughters to the San Francisco Folsom Street Fair (FSF) decked out in lace shirts and studded black leather dog collars. This event is a long-running annual event at which the BDSM world displays its wares – people, props, and all. While all sexual orientations participate in the display areas, it’s heavy on male/male power exchange demonstrations.

When questioned, these two fathers said that they wanted their daughters to be exposed to the diverse community of San Francisco. I’m all for diversity and letting children have healthy opportunities to eventually develop a pleasurable sexuality – but how taking two toddlers to this event contributes to that completely escapes me.

Let children be children. Offer them a steady and gentle dialogue with their parents about sexual matters. A buffet of paraphilias really doesn’t contribute – and may just cause nightmares.

I don’t have an argument with the people who wanted to participate in this event. There were entrances with FSF staff informing people when they entered that this was not for the faint of heart. One does not accidentally wander into this mecca of extreme sexual intensity.

According to all reports, nothing happened to these two little girls. The fathers kept a watchful eye on them as they wandered in the midst of some partially clad and some completely nude people. I suppose that two young children could also play on a freeway and come away unharmed. But why even take such a chance?

The FSF offers displays of spanking, whipping, extreme bondage, piercings, and highly unusual role playing. Don’t get me wrong – the people are having a good time, a really good time. More power to them – or, uh, from them. There’s just no reason why a child should have the opportunity to take this all in.

Many adults would have a hard time stomaching the graphic nature of what causes pleasure to some of humankind. Why should a child have to unravel a reenactment of a quasi-Nazi commandant with a few extremely bound captives. And what about that guy with the fish hooks in his back? “Daddy, doesn’t that hurt?”

A few weeks ago, I complained here that I didn’t want to have to explain to my sons that some people choose public restrooms for sexual contacts and what the sounds coming from the next stall were about. I certainly have no desire to explain how some people develop a type of intensity about their sexuality that speeds on by that of most other people.

I remember when Janet Jackson had her “wardrobe malfunction.” My son happened to see the performance of a song during that same Super Bowl halftime that had some unmistakable BDSM visual content. A breast, that was relatively easy to explain. That some people feel very, very good in the midst of this type of power dynamic – how does one explain that to a four-year old? We’ll get to that in our ongoing sex ed dialogue, but in due time – in due time.

Much has been written about how this sets gay rights back a few centuries much to the Far Right’s glee. (Yeah, this newsworthy decision by these fathers couldn’t have helped.) Others have chimed in about the importance of accepting human nudity. (How about a nudist camp or beach for that?) But where the real pay dirt is for me on this one concerns the kids.

Dressing kids up in fetish wear makes about as much sense as putting a Halloween costume on your cat. No, it makes far less sense. I actually don’t really care that much about the anthropomorphizing of a cat, but I really can’t think of any good reason to prompt even a pseudo-sexual image that involves two-year old girls. (This goes for child beauty pageants too.) Perhaps these men thought that they were just getting into the spirit of the fair. Perhaps they wanted others to know that they had their daughters there on purpose, not by accident. Perhaps they wanted us to know that extremely poor parental judgment does not discriminate based on sexual orientation.

We can speculate all we want about the underlying psychological reasons they made this choice: they see their children as fashion accessories; they want to inspire envy in other gay fathers; they’re working out their own exposure to confronting images and what it did to them – and so on. But, it doesn’t feel like speculation at all when I picture child protective services paying them a visit.

Related Topics:

Technorati Tags: child development, sexualize children, sex education, Folsom Street Fair, BDSM

Posted by: WebMD Blogs at 7:03 am

Monday, October 1, 2007

From the Sex Files: A Father and Son Talk

I was struck this week by a client’s description of the “birds and bees talk” he got when he was about thirteen. His father suddenly said to him one day, “Let’s go fishing this weekend.” Fishing wasn’t one of their regular activities, so even at thirteen, my client knew that something was up.

So, there they were – father in the front seat driving and son in the back seat looking at the back of his dad’s head. Father was sweating bullets. Nevertheless he lurched along with some vagaries about sex being one of the great and beautiful things in life, in a marriage, between husband and wife. Then there was some more verbal stumbling and mumbling around that didn’t make a lot of sense.

Then, his dad sort of turned his head and said, “We good? … Great … (phew) … so … you hungry? Let’s eat.” The sex talk was now complete.

My client meanwhile had already gotten what he now refers to as his mom’s “meta message” – that sex before marriage would lead to burning in hell and disease – not that she had ever said those exact words to him. So, he now had the total sex education he could expect from his parents by age thirteen – both very one-sided communications and none of it eyeball to eyeball involving any dialogue.

I can’t say that anyone has ever painted such a vivid picture of parental discomfort as this man did in his description of his fishing trip drive. He, admirably enough, has come to an acceptance of his father – both his strengths and his shortcomings.

My client told me this story because I had asked about it. We had been investigating some earlier life experiences that may have led to some of his adult decisions about sex. So far in his life he had participated in secretive sex outside his marriage and again in a later primary relationship. In his new marriage, he had almost begun in that direction.

Though at the time I did not make any specific connections to the sex talk and the sexual straying, I did find this sex talk scenario poignant. I realized that if parents need to make it impossible for their children to look them in the eye, they might as well hand them a book and say, “Read this.” At least then, they’d get some information instead of only visible perspiration.

Here are three books that I really like to suggest for sex ed moments both for the tongue-tied and those who are more comfortable:

It’s Not the Stork: A Book about Girls, Boys, Babies, Bodies, Families, and Friends, by Robie Harris. It’s aimed at ages four and up (or younger if this child has older siblings, is an “older” three, or if you want to sit and talk it through one or two pages at a time).

It’s So Amazing! A Book About Eggs, Sperm, Birth, Babies, and Families, by Robie Harris. It’s aimed at age seven and up. (I’ve used this with my five-year old, but with lots of dialogue.)

It’s Perfectly Normal: Changing Bodies, Growing Up, Sex and Sexual Health, by Robie Harris. (I find ten the right time to start with this book.)

Parents often lament the sexualized culture in which their kids grow up. Here are some very handy tools to weaken the impact of that culture and to strengthen the impact of their family’s values on that topic.

Related Topics:

Technorati Tags: sex talk, Sex Files, health and wellness

Posted by: WebMD Blogs at 2:32 pm

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