baycobi

HEALTH

The Wall Street Journal
Nov. 4, 2003

His and Hers *** Drugs

In Search of 'Female Viagra,' Doctors Try Antidepressants, Testosterone, Even
Ritalin

By JANE SPENCER

Staff Reporter of THE WALL STREET JOURNAL

After her daughter was born 28 years ago, Lillian Arleque lost interest in ***.
Nothing put her in the mood. She could no longer have ******s. "A switch just
shut off," she says.

For more than two decades, doctors shrugged off her complaints and suggested
therapy. But Ms. Arleque, who says she was otherwise content with her marriage,
life, and career, was convinced her lack of desire had a physical component.
Last spring, she began seeing a doctor specializing in ***ual medicine who
offered a novel suggestion. He began prescribing hormones like testosterone,
and tried remedies typically used for men, like Viagra and Levitra.

The drug ****tail has worked. The 57-year-old business consultant says her ***
drive has come back, and she and her husband are "making up for lost time."

While the pharmaceutical industry continues to hunt for a female version of
Viagra, a growing number of doctors are offering women existing drugs that have
been approved for other ailments. The controversial treatments range from
libido-boosting hormones like testosterone, to neurotransmitters like
Wellbutrin, an antidepressant that some recent studies show may trigger an
increase in ***ual fantasies.

In more experimental settings, doctors are also prescribing men's *** drugs
like Viagra and Levitra, which can increase blood flow to *** organs. Others
are trying stimulants like Ritalin to counteract the libido-dulling effects of
SSRI antidepressants, like Prozac and Zoloft, which are taken by more women
than men.

Most of the drugs being prescribed are not approved by the Food and Drug
Administration to treat ***ual problems in women. But in a practice known as
off-label use, doctors can legally prescribe drugs for any reason if scientific
evidence suggests they may be effective. The risk is that long-term effects
haven't necessarily been tested.

Some of the new treatment is happening in clinics that specialize in women's
***ual health. But many mainstream doctors and gynecologists are prescribing
the more-tested remedies like testosterone. Stephen Feldman, owner of the
California Pharmacy and Compounding Center in Newport Beach, Calif., says his
pharmacy has filled about 3,000 prescriptions for testosterone for women in the
past year, a rate that has drastically increased in recent years. Shari
Goldman, a Chicago gynecologist with a general practice, says she considers
testosterone therapy for the roughly 10% of her patients who complain of low
libido.

Interest in the new remedies is getting a boost in the aftermath of concerns
over hormone replacement therapy. For many older women, HRT helped counteract
some of the consequences of menopause, such as ******l dryness. But after
widely publicized reports that the most popular form of the therapy may
increase breast-cancer risk, many women abandoned the treatment.

Some doctors are pushing topical estrogen treatments and supplements as an
alternative, such as Vagifem, Estrace, and Premarin cream, which are applied
directly on the genital area. A new product called FemRing, introduced to the
U.S. market in July by Galen PLC, is a flexible silicone ring that releases
estrogen to help increase lubrication. Another product, called EstraTest,
combines estrogen with testosterone. But it contains methyltestosterone, which
may not have the same impact on libido as other forms of testosterone.

Industry Scramble

Prescription options could expand in the coming years, as pharmaceutical
companies scramble to be first to market with a blockbuster *** drug for women.
Procter & Gamble is conducting tests of a testosterone patch. Pfizer is testing
a version of Viagra on women.VivusInc. is testing an arousal cream called
Alista that is intended to increase blood flow. Drug companies hope the market
could top the $2 billion market for erectile dysfunction.

But the efforts are spurring a backlash from critics who say the pharmaceutical
industry is inventing a medical problem to create a new market. While male
***ual dysfunction is often reduced to the mechanical issues of erectile
dysfunction, female ***uality is a complex issue that lies at the intersection
of psychology and biology. Depression, stress, relationship issues, past ***ual
traumas and body image all affect desire and arousal in women. Many doctors say
that ebbs and flows in women's ***ual appetites are entirely natural reaction
to cir***stances and aging, and should not be classified as "dysfunction."

Many doctors leading the research on female ***ual dysfunction receive funding
from drug companies. The Female ***ual Medicine Center at the Department of
Urology at University of California at Los Angeles receive money from Pfizer
and Vivus. The Institute for ***ual Medicine at Boston University School of
Medicine, where Ms. Arleque was treated, has received funding from Pfizer, Eli
Lilly and Bayer.

Questionable Statistics?

Drug companies often cite statistics suggesting that 43% of women experience
some form of ***ual dysfunction, ranging from trouble having an ******, to low
libido, to pain during ***. The statistic, however, comes from a 1999 article
in the Journal of the American Medical Association that has been criticized for
relying on old data and overgeneralizing.

But gynecologists say low libido is a common ***ual complaint among their
patients. While emotional factors like stress and relationship concerns are
often the primary cause, dozens of prescription and over-the-counter drugs for
a variety of conditions have side effects that may affect ***ual function.
Birth-control pills, for example, limit women's ability to produce
testosterone, a hormone that influences ***ual arousal. Many SSRI
antidepressants and antianxiety medications, including Prozac, Paxil and
Zoloft, have been shown to reduce *** drive.

Common surgical procedures, conditions and diseases may also have an impact.
Hysterectomies, nerve damage during childbirth, and illnesses that affect blood
flow, like high cholesterol, may also affect ***ual function. (Some doctors say
prescribing Lipitor can improve ***ual performance in both men and women.)

Herbal Remedies

As interest in the medical side of female ***uality grows, an expanding array
of herbal remedies with names like "Exotica" and "Steel Libido" are also
hitting drugstore shelves and showing up in spam advertising. Many of them are
minimally effective and loaded with irritants like orange oil and menthol. But
a few herbal remedies have shown promising results in clinical trials. Some
doctors say Zestra, a homeopathic mixture of botanical oils can create a
tingling sensation and increase blood flow to genitals. They're also suggesting
ArginMax, an amino acid supplement that may increase blood flow to the
genitals.

For many women, declining *** drive is an inevitable consequence of aging. From
an evolutionary perspective, libido is associated with procreation, and doesn't
serve much purpose after menopause. Levels of testosterone, one of the hormones
that regulates libido in women as well as men, drop by about half in females
between the age of 20 to 40. The decline in libido may be compounded by
menopausal side effects, such as thinning of the ******l tissue and a decrease
in lubrication, which can make intercourse painful.

But many women in their 50s and beyond aren't ready to give up on ***. "Viagra
has done a remarkable job of increasingly awareness and expectations in
advancing years," says Shari Goldman, a Chicago gynecologist.

Testosterone, one of the most commonly prescribed remedies, is technically
approved by the FDA only for use in men. Testosterone supplements have a
booster effect that can effectively trigger a state similar to the onset of
puberty: It can spur an increase in ***ual appetite, along with other changes
including facial-hair growth, acne and a deepening of the voice.

For women such side effects can be extremely unpleasant. Most of the
prescription products now available, such as AndroGel and Testim, come in high
doses developed for men who have about 10 times as much testosterone as women.
Doctors treating women have to prescribe these highly concentrated products in
less frequent doses -- or go to special compounding pharmacies that will mix
lower-dose products for women.

Guessing Game

Determining the right dose is a guessing game, since the hormone seems to
affect women differently. "This is cookbook medicine," says Jennifer Berman of
the Female ***ual Medicine Center at UCLA. Doctors should keep careful tabs on
their patients blood level -- and many women report no difference at all in
their *** drive after taking it.

Doctors are also testing drugs that work on the brain, like bupropion, the key
ingredient in some antidepressants like Wellbutrin. One recent study, conducted
in part by Anita Clayton of the Department of Psychiatric Medicine at the
University of Virginia, suggested it may be effective in women who complain of
low *** drive, who are not otherwise depressed. Currently, however, doctors
generally prescribe Wellbutrin only to patients to counteract the ***ual side
effects of other antidepressants.

Despite the critics, some argue that women should be relieved that the physical
side of women's ***ual complaints are finally being addressed. Women have been
told "to go home and have a glass of wine, lose a few pounds or get some
therapy," says Laura Berman, a *** therapist and director of the Berman Center,
a Chicago organization devoted to women's ***ual health. "But the medical
community is finally coming on board."

* * *

Options for Women

Doctors are increasingly suggesting prescription drugs and herbal remedies to
treat women's ***ual problems.

PRESCRIPTION DRUGS: Testosterone (AndroGel, Testim and products mixed for women
at specialty pharmacies)

APPLICATION: Known as the "hormone of desire," it's prescribed for women who
complain of low *** drive. Not approved by the FDA for use by women.

COMMENT: Has many unpleasant side effects including hair growth, muscle mass
increase and deepening of the voice.

PRESCRIPTION DRUGS: Wellbutrin (Bupropion)

APPLICATION: An anti-depressant without the libido dulling effects. It may also
boost ***ual thoughts in women who are not depressed.

COMMENT: The drug is currently being prescribed to replace or counteract other
antidepressants.

PRESCRIPTION DRUGS: Viagra/Levitra

APPLICATION: Both drugs increase blood flow to the genital areas, which some
doctors say could improve "engorgement" in women. Approved by the FDA only for
men.

COMMENT: Initial studies of Levitra in women have been "disappointing"
according to its maker.

PRESCRIPTION DRUGS: FemRing/Topical Estrogen

APPLICATION: A silicon ring that is inserted into the ****** and releases
estrogen. Used to treat menopausal symptoms, including ******l dryness.

COMMENT: Topical estrogen products, including Etrace and Vagifem, have similar
effects.

NON-PRESCRIPTION REMEDIES: Zestra

APPLICATION: A lotion containing ingredients like borage seed oil, evening
primrose oil, and coleus extract that creates a tingling sensation. Claims to
increase blood flow and "nerve velocity."

COMMENT: The treatment has been through a small clinical trial and some doctors
say the results stand up to scrutiny.

NON-PRESCRIPTION REMEDIES: ArginMax

APPLICATION: A pill that contains an amino-acid that may increase blood flow to
the genital area.

COMMENT: Has been proven effective in placebo controlled studies.

NON-PRESCRIPTION REMEDIES: Avlimil

APPLICATION: A daily supplement that claims to "restore your sensuality." The
treatment has been widely advertised in a slick ad campaign as the female
equivalent of Viagra.

COMMENT: Some doctors are skeptical about its efficacy and the clinical trial
posted on its Web site.

Write to Jane Spencer at jane.spencer@wsj.com4

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gemini_06

Check out:

http://avlimil.com

ernie

Hi All,

Enjoyed reading the WS article..

The wife has been receiving pellet hormone replacement therapy for more than
10 years. She was given oral medication which was ineffective. When she
complained she was not better, they told her it was all in her head and go
to a psychiatrist without doing any blood tests to find out she was in the
15% or so group of women who do not benefit from oral estrogen. Bad
medicine.

A friend sent her an article about pellet theray that was available in NJ, 3
hours away and she was back to her old self in a few days.

Testosterone pellets were also included an a normal part of her treatment as
this had been developed by Dr. Greenblatt, now deceased, of Augusta, GA who
pioneered hormone therapy for men and women probably beginning in the 50's.
He is the earliest pioneer in hormon therapy I am aware of. He trained over
100 doctors who are now in their 70's and many deceased. He was the first to
suggest there is a need for women to have progesterone for 7-9 dsays per
month along with their HRT.

3E and 2T pellets were inserted under the skin every 4 months and dissolve
gradually into the blood stream.

Her ability to have an ****** stopped 1998 after she had a stroke and went
on anti-depressant medications and there may also be other medications that
have an adverse effect here. She is now 71. I understand nerves gradually
age and the sensitivity goes south making ****** impossible for many women
late in life if they are fortunate.

She rushed off to Boston when the Berman sisters were in the same office as
Dr. Goldstein, Boston Univ. She was given viagra but with no benefit.

For more than 10 years the wife had the benefit of both of the primary ***
hormones that were ignored until recently as more attention is now building
for adding the essential T hormone along with ERT.

Dr. R. Don Gambrell, trained by Dr. Greenblatt is now located in Augusta, GA
and has a web site at:

http://www.members.aol.com/gambr999/

ernestnolan