doctor in a white coat holding a green medicine bottle, sitting across from a patient

It’s been 18 years since the landmark Women’s Health Initiative (WHI) initial hormone therapy (HT) results. They gained worldwide attention by throwing HT “under the bus,” alleging the risks outweighed the benefits. I didn’t, and still don’t, endorse that conclusion, because estrogen therapy reduces the risks for heart disease, Alzheimer’s disease, and osteoporotic fractures among other benefits. Regardless of one’s point of view, almost 80% of women abruptly went off their HT.1 Here, I want to talk about the latest “potential” benefit of estrogen therapy… prevention of COVID-19 infection, and reduction in disease severity. Yes, you heard me, I can’t make this “stuff” up!2,3

The basics are these:

  • The severity of coronavirus infection appears to be greater in men than in women.
  • Estrogen reduces both influenza virus growth (replication) and the inflammation it causes.
  • These benefits of estrogen (replication and inflammation) are eliminated in animals when they lose ovarian function, like menopause, and are restored if those animals receive estrogen.
  • Pregnant women have high levels of reproductive hormones, including estrogen. 92% of pregnant Chinese women from Wuhan with COVID-19 had mild symptoms, and the other 8% all recovered from their disease. There were no deaths in pregnant women.

Taken together, estrogen seems to be protective against COVID-19, both the prevention of infection, and reduction in disease severity. So much so that clinicians and scientists from Stony Brook University Hospital in New York have launched a clinical trial using menopausal estrogen patches for the reduction of COVID-19 severity in both women and MEN!4,5 Yes, we are now giving menopausal estrogens to MEN. So, before you throw away your menopausal hormone therapy, think twice, it may be helpful in this COVID-19 pandemic.

 

  1. Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol. 2012;120(3):595‐603. doi:10.1097/AOG.0b013e318265df42
  2. Suba Z. Prevention and therapy of COVID-19 via exogenous estrogen treatment for both male and female patients. J Pharm Pharm Sci. 2020;23(1):75‐85. doi:10.18433/jpps31069
  3. https://www.healio.com/endocrinology/hormone-therapy/news/online/%7B334d4dd8-cc70-4672-952f-735440eef7da%7D/study-investigates-estrogen-patch-use-to-lessen-covid-19-complications
  4. https://clinicaltrials.gov/ct2/show/NCT04359329
smiling woman

older woman sitting on a couch, smiling

Testosterone Therapy

I have been involved in the development of testosterone products for women for many years. My research has been included in the original Princeton Consensus on Testosterone Insufficiency in Women back in 2002, and in the testing of Estratest and Estratest HS for female sexual function (both of which are still on the U.S. market), in the development of the Intrinsa Testosterone Patch for women by Proctor and Gamble, (which was never approved by FDA, but was approved and available for years in Europe), as well as in a testosterone gel for women, Libigel (which also failed to win FDA approval). Some of my additional publications on this topic can be found here

Needless to say, after all of this time, I am grateful to have been part of the International Menopause Society’s global consensus that testosterone treatment for post-menopausal women is viable and useful for female sexual dysfunction. It is time the medical community accepted this so that women can get the help they need and start feeling like themselves again for the second half of their lives.


What are the benefits/risks of testosterone supplementation? 

The primary benefits discussed in the global consensus include increased interest in sex and easier arousal and orgasm, but testosterone also contributes to increased lean muscle mass, increased bone density, and improved energy and sense of well-being. 

There literally are no risks to proper transdermal testosterone therapy if testosterone levels are kept within the normal range. If testosterone exceeds the normal range (and this can easily happen when women use men’s products not approved for use by women) women can sometimes: lose the hair on their heads, develop dark facial hair – even beards – get hairy elsewhere, have their voices change to a lower register, get an enlarged clitoris which can be too sensitive, and possibly increase one’s risk of heart attack or venous blood clots.

When testosterone treatment is taken under a doctor’s supervision and properly monitored, these side effects will typically not occur.

 

What patient population is testosterone treatment indicated for? 

All postmenopausal women may benefit from testosterone treatment, but particularly those with induced menopause (i.e. women who have had their ovaries removed, have had their ovaries radiated [even accidentally] and ovary failure ensued or had chemotherapy and their ovaries failed as a result). 

 

Testosterone and Sex Drive

I recently described a dose-response relationship-specific for testosterone for sex in women and how it is different for testosterone for sex in men. Basically, women can get too much testosterone, and it either does not increase and may actually decrease their interest in sex. As current President of ISSWSH, The International Society for the Study of Women’s Sexual Health we have nearly completed a “how-to” paper on how to use testosterone in women. In the absence of an approved product specifically for women, and the possible negative side effects of inappropriate use at high doses, this publication will be used a practice “bible” for uses of testosterone in menopausal women in the future.

 

If you think you might benefit from testosterone therapy…

Call us and make an appointment at 202.293.1000. We take the time with each of our patients to determine possible causes of complaints and develop a treatment plan that will work for you. Don’t wait to start living your life again, so make that call and let us help you!

an open bottle lying on its side with golden capsules emerging and on the table beside it

Sex supplements are everywhere and easy to access, but do they actually work?

Studies have shown that even Viagra, an FDA-approved prescription drug, has a placebo effect of over 30%, which tells me that if you believe Viagra or a sex supplement will work, it just might. But is it worth the negative effects that sex supplements can have?

Most sex supplements include ingredients that have not been tested or studied and may not be safe at all to take. Several common ingredients in sex supplements, including ginseng, yohimbe, tribulus, and ginkgo biloba, can have adverse side effects from headaches to seizures. It is just not worth it!

There are several FDA-approved options for you that are both safe and effective, such as Addyi for women or Viagra and several similar medications for men. Addyi helps women who have HSDD, or Hypoactive Sexual Desire Disorder, which is the most common form of sexual dysfunction in women. HSDD by definition is lowered sexual desire. If you’re unsatisfied with your current level of sexual desire, or feel as if you had a higher desire for sex before, you might have HSDD, and Addyi could help! Viagra and several similar medications are common treatments for erectile dysfunction or ED, which can even effect men in their 20s. It’s not just for seniors! In fact, 50% of men in their 50’s, 60% of men in their 60’s and 70% of men in their 70’s have ED.

We also specialize in hormone replacement therapy, which can be used to treat a myriad of symptoms, including low libido and low testosterone. Hormone replacement therapy is safe to use, and we will create a cocktail of hormones specific to your body’s needs. Sometimes we can even package it up in a pellet, which we would then insert under your skin in a quick and relatively painless office procedure, so you can forget about it and get on with enjoying your life!

In addition, we will work with you to find out the root of your sexual problems, not just treat the symptoms. Just getting enough sleep or making small changes to your diet and exercise can improve sexual function, and make you feel a whole lot better. Maybe seeing a sex therapist will help you and your partner uncover what is holding you back. There are a number of effective ways to treat sexual dysfunction, but taking sex supplements is not one of them!

I understand the appeal to buying “over-the-counter” sex supplements instead of talking to a doctor about your sexual problems. It can feel embarrassing to talk about, and it’s been documented that many primary care physicians are equally awkward and embarrassed when the topic is breached, which is why seeing a sexual medicine specialist is a way to go. Sex is our bread and butter. We welcome the awkward questions!

Make an appointment to see one of our experts by calling 202.293.1000. Leave the sex supplements behind and get a tailored treatment plan that will actually work for you.

Doctor and patient, women

Catching Cancer in Patients with Lynch Syndrome

Does your patient have cancer in their family history? If they have Lynch Syndrome, a simple screening can catch cancer before it’s too late.

It’s easy to merely glance over the obligatory medical history form that new patients fill out, scanning for information pertinent only to their presenting problem. But, as we at IntimMedicine Specialists look over a new patient’s medical history, we are always on the “look out” for a family history of cancer. How about a family history of Colon, Uterine, or Ovarian cancer? These and a number of other cancers could indicate that you and your family has Lynch Syndrome.

Lynch Syndrome is named after Dr. Henry Lynch, who is considered the father of hereditary cancer. He named this syndrome the “Cancer Family Syndrome” in 1966, which was later called “Lynch Syndrome” in 1984 by other authors, after which point Lynch himself began calling it Hereditary Nonpolyposis Colorectal Cancer, or HNPCC. It is now known as HNPCC or Lynch Syndrome, and it is characterized by members of the same family line born with a predisposition to develop ovarian, colorectal, endometrial, or other cancers.

For those of us in the fields of sexual health, we are in a unique position to be able to spot this syndrome and help our patients get the screenings they need to catch these potential cancers early. 1 in 400 people are at risk for Lynch Syndrome. It is projected that up to 1 million people in the United States have Lynch Syndrome, but due to a lack of public education about it, only about 5% of people who have Lynch Syndrome have been diagnosed with it.1 Patients with Lynch Syndrome are at a much higher risk of developing these cancers, and it is recommended that their screenings start at an earlier age and are repeated more frequently than patients without Lynch Syndrome. For example, a patient with a family history of colon cancer starting before age 50 might have Lynch Syndrome, and it is recommended that they begin colonoscopies at age 20-25, rather than wait until it may be too late.

IDENTIFYING LYNCH SYNDROME

  • If a patient has a family history of colon cancer – particularly if a family member developed colon cancer before age 50
  • If a patient has a family history of extracolonic cancers including endometrial, ovarian, small bowel, biliary, renal pelvis, ureter, or glioblastoma (a particular brain cancer)
  • If a female patient has abnormal uterine bleeding and a diagnosis of complex endometrial hyperplasia or endometrial cancer and she is younger than age 50

If any of these criteria are met, it is time to order a hereditary cancer panel. This panel will test for multiple cancer syndromes at once and is now the standard of care.

We are in a unique position to be able to catch cancer before it strikes. Ask your patients more about their family history of cancer. A simple screening process can make all the difference.

The specialists at IntimMedicine are experts in post-cancer sexual health. If you or a loved one is being treated for cancer or has been treated for cancer, talk to us at 202.293.1000, or email us at info@intimmedicine.com.

Learn more about Lynch Syndrome in this article.

1 https://www.contemporaryobgyn.net/gynecologic-cancers/keys-identifying-lynch-syndrome

closeup of a doctor with a stethoscope in his pocket and a sexual health pin on his lapel

We are pleased to share a recent article in Washingtonian Magazine featuring an interview with our own Dr. James Simon, “The Menopause Whisperer!” In the article, Dr. Simon discusses female sexual dysfunction, the state of sexual healthcare for women, and his hopes for its future.

Read the article “Sexual Dysfunction in Women Has Long Been Taboo. Washington’s Menopause Whisperer Is Here to Help.” in Washingtonian Magazine

Here is an excerpt from the article about one of Dr. Simon’s patients:

Palim stumbled on a Washington Post article that mentioned Simon’s practice; he put her on testosterone, and her condition rapidly improved. But if she hadn’t happened upon that story, “that might have just been the end for me of a part of my life and of my relationship with my husband that was meaningful and fun—and why? Why should I have had to give that up just because nobody bo

 

If you know someone who might benefit from seeing Dr. Simon or one of our sexual medicine experts at IntimMedicine Specialists, please feel free to share this post with them, or call us at 202.293.1000to make an appointment for yourself.

Pellet Hormone Replacement FAQ

We know that Hormone Replacement Therapy is essential for managing severe menopause (or “manopause!”) symptoms, and hopefully there is an easy way to deliver it, right? Fortunately, there is! IntimMedicine offers an easy outpatient procedure to place a bioidentical hormone pellet under the skin. Outta sight, outta mind, and you get to start living your life again!

What is it?

Pellets are compounded bioidentical hormones for women (our team of experts will determine exactly what’s right for you – the right amount can help you regain your hormonal balance). Pellet therapy is actually FDA approved for men, as well. Pellets are typically naturally occurring hormones that are pressed into a solid, little insert, about the size of a grain of rice.

How does it work?

Your pellet will release a small amount of your hormonal regimen straight into your bloodstream, similar to what your ovaries or testes would normally have produced in your younger years. Research shows that pellets are able to deliver a consistent level of hormones to your body, unlike some creams, gels, or pills which are also compounded. Pellets also reduce the risk of blood clots (venous thrombosis) associated with oral hormone replacement therapy because the hormones released from pellets enter the bloodstream directly and do not cause changes in blood clotting factors made in the liver the way oral medications can. It’s a win-win!

How is it used?

Hormone Replacement Pellets are used like any other Hormone Replacement Therapy to help our bodies regain some of its hormonal balance, which will improve everything from the emotional roller coaster to hot flashes. The pellet is just a convenient delivery method! It’s not for everyone, but getting your hormones “just right” no matter the method is critical.

How long does the procedure take?

It is a quick and painless (with numbing medication) outpatient office procedure. We will insert the HRT pellet right into your hip, abdomen or buttock area, and you’ll be on your way and back to your life!

How long till I see results?

It will only take 7-10 days for you to notice your HRT Pellet working on your symptoms.

How long will my pellet last?

HRT Pellets typically last 3-6 months for men and women.

How can I make an appointment? Call us at 202.293.1000 or email us to set up a consultation appointment with one of our specialists here in Washington, DC. Don’t wait to get back to living your normal life – call us today!

man and woman in bed, separated, unhappy

Study Shows that Deep Dyspareunia can Improve with Interdisciplinary Treatment

There is good news for women who are suffering from Deep Dyspareunia! Dyspareunia is the fancy medical term for painful sex, and can be categorized two ways: superficial (affecting just the entrance of the vagina or vulva), or deep (pain during deep penetration).

In a recent study published in the Journal of Sexual Medicine, researchers had 278 women self-report pain scores related to their Dyspareunia symptoms on an 11-point scale. The women and their physicians decided which treatment options to pursue, including “minimally invasive surgery, hormone therapy, pain education, physiotherapy, or psychological therapy” (ISSM). This is what is considered an “interdisciplinary approach,” since treatments were not limited to one course of action.

After a year, researchers followed up with the women who participated in the study and found that the 28% of women who had reported absent or mild pain had increased to 45% of women, the 17% who rated their pain as moderate increased to 25%, and the 55% of women who said they were experiencing severe pain decreased to 30% of women. These are great results and should give hope to women who are still experiencing painful sex!

It should be noted that having depression and being at a younger age were considered predictors for having continuing deep dyspareunia after a year, because depression can also “affect the sexual response cycle, pelvic floor function, relationships with partners, and emotional aspects of pain” (ISSM). More research needs to be done about how depression can affect deep dyspareunia, but the authors of the study recommend treating your depression first and foremost should you be suffering from it, as your other symptoms can improve with that treatment.
Because the women and their doctors chose different plans of action to treat the symptoms, we can’t be sure exactly which treatments were most effective, but the bottom line is that after only a year your symptoms can improve if you are able to attack the problem holistically. That’s where we come in. IntimMedicine Specialists are well-known for our holistic, tailored approach towards treating our patients. If you are experiencing painful sex, give us a call, or e-mail us! Our experts here in Washington, DC would love to discuss which options to try with you to start treating your pain and improve your sex life and beyond!

Dr. Rachel Rubin of IntimMedicine Specialists

Dr. Rubin at Planned Parenthood DC’s “I Like It” Event

“Nobody taught us about the clitoris in medical school, and doctors rarely ask women if they can orgasm…but they should!”

That’s what our very own Dr. Rachel Rubin told the audience at a local Planned Parenthood “I Like It” a fundraising event held at George Washington University earlier this year. 

The discussion followed a screening of “The Female Orgasm,” an episode of the Netflix Original Series Explained. Dr. Rubin, joined on the panel by a sex therapist and sex educators, discussed the “orgasm gap,” what happens to the body during female orgasm, and ways to talk about what feels good. You can watch highlights of the discussion here.

panel members at "I Like It" at Planned Parenthood DC

Dr. Rubin is a board-certified urologist with fellowship training in sexual medicine. She believes in a multidisciplinary and individualized approach to care for men, women, and couples, with the first step being an in-depth consultation with enough time to truly understand her patients’ concerns.

Follow Dr. Rubin and follow IntimMedicine on Twitter to find out about future events where you can hear Dr. Rubin and our other experts speak.

 

Men have Pills for their Sexual Dysfunction, Why Can’t Women?

A Response to “How Addyi, the ‘Female Viagra,’ Can Do More Harm Than Good” By Dr. James A Simon

Earlier this month, Dr. Janet Brito, a sex therapist based in Hawaii, raising a few questions about the efficacy and wisdom in using Addyi, known as the “Female Viagra,” to treat sexual dysfunction in women. The article she wrote has been removed from that site that posted it due to the inaccuracy of the information the article contained. In spite of this, I felt that it was important to address her concerns, and to explain how Addyi is, in fact, an empowering tool that women who are suffering from hypoactive sexual desire (HSDD) or female sexual interest/arousal disorder (FSAD).

Efficacy and Use

Regarding the efficacy and use of Addyi, Dr. Brito makes several claims that are either blatantly false or not based in fact. She states that Addyi “needs to be taken every day for at least 8 to 16 weeks before it starts working.” According to the package insert itself (approved by the FDA), if Addyi isn’t working by 8 weeks, its use should be discontinued.

Brito brings up the fact that “according to the Addyi website, ‘it’s exact mechanism of action is not fully understood,’” without any other comment, perhaps implying that this is a reason it should not be used, but this fact is also true for all antidepressants, pain killers, appetite altering medications and most medicines generally.

“Initially, flibanserin was slated for the treatment of depression. After two rejections by the FDA, Addyi was approved in 2015 to treat low sexual desire in premenopausal women — despite trials showing only minimal results compared to a placebo,” states Dr. Brito. Addyi was originally developed to treat depression, but in people with major depressive disorder where Addyi didn’t work for depression, it increased sexual desire. That’s correct, it worked to increase sexual desire even in women that were clinically depressed.

Thus, the company behind Addyi pursued sexual dysfunction as an option to help women suffering from hypoactive sexual desire disorder or HSDD or female sexual arousal disorder or FSAD. The drug was rejected twice by the FDA, in my opinion, because the FDA kept changing their mind about what they wanted.

The company was trying to develop a first-in-class medication where the tools for assessing efficacy weren’t invented yet. For responders to the medication (excluding all the non-responders), they had 5.7 sexual events per month, which can’t be considered minimal, and which the responders themselves judged as a meaningful improvement.

“Their desire stats did change and show an increase when researchers measured it according to the Female Sexual Function Index — but if participants didn’t notice their own response, can it really be considered effective?” asks Dr. Brito. The Female Sexual Function Index is a validated questionare answered by the study participants, an approach agreed upon with the FDA. Participants reply to the FSFI based on how they, the participants, feel.

Social Oppression and Relationships

Dr. Brito spends a great deal of the article drawing a connection between a pill to treat sexual dysfunction for women and a long history of societal oppression of women. I fail to see the connection, as Addyi is only prescribed to patients who wanted to increase their sexual desire for one reason or another, not because their partners or society had problems with their libidos as Brito suggests.

Brito’s other accusation that those who prescribe Addyi are not taking into account any of the other factors that might contribute to low sexual desire, is not based in fact. Study participants were excluded from entering the research studies if they had any other reason for their loss of sexual desire, any reason. Such reasons would have included: depression or other medical conditions, medications known to affect sexual function, and any relationship problems, just for examples. Erectile Dysfunction has many causes and factors, and yet men are prescribed Viagra without a second thought. Shouldn’t women have equal access to a pill that can help them with their sexual function, too?

Like those who are prescribed a pill for depression, Addyi can help women start living their lives again, and get back to their old selves.

Brito also writes, “…sometimes the issue is about the relationship you have with yourself, not others.” On this point, I totally agree. But women with relationship problems with themselves or their partners were excluded from the clinical development of Addyi as noted above. Addyi is there for women who have been diagnosed with HSDD or FSAD, who are in a healthy relationship with their partners, and who want to get back to enjoying their partners sexually.

Dr. Brito concludes the article with this line, “Instead, ask yourself, honestly, if any of the aforementioned factors are impacting your life. And, if so, what lifestyle changes to embark on to start to feel better on your terms.” Addyi, Viagra, anti-depressants, and a slew of other medications may not be the best choice for every patient, but the patient does have a choice.

Why a sex therapist (who cannot even prescribe Addyi or medication generally) is ruling out a drug that is effective, readily available, and which delivers on the promise to increase “sexual desire and satisfying sexual events,” is beyond me.

To discuss if Addyi might help you or determine if you might be suffering from HSDD or FSAD, give us a call at 202.293.1000 or e-mail us to make an appointment at our office in Washington, D.C.

man pretending to eat the sun
Daily Dose of Vitamin D

Maybe you’ve heard of taking Vitamin D supplements to help slow down bone loss, but what about taking it to improve your sexual function and satisfaction?

According to a recently published study which took place in Italy over the last 15 years, Vitamin D deficiency might play a part in erectile dysfunction and other sexual dysfunctions in men. Each of the 114 participants were assessed for five aspects of male sexual life, including erectile and orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction, and over the course of the study, researchers found that higher levels of Vitamin D was associated with higher scores for all five of those aspects.

Some of the participants of the study were given Vitamin D supplements over the course of their treatment for sexual dysfunction. “Vitamin D levels are directly able to influence all sexual function parameters,” the authors of the study wrote. “Evaluation of our study clearly shows the improvement of erectile function after vitamin D replacement therapy.”

Vitamin D is also a necessary nutrient for both men and women’s health, and Vitamin D deficiency has been linked to various cancers, cognitive impairment in older adults, depression and tiredness, and an increased risk of heart disease, so it’s worth making sure you’re getting a sufficient amount of Vitamin D even if you are satisfied with your sexual function. It can be difficult to know that you’re getting the right amount of Vitamin D just from exposure to the sun, and particularly during the Winter it can be tough to get enough sunlight. Seasonal affective disorder (SAD) is linked to a lack of Vitamin D during the winter months and rainy seasons, and results in depression. All of this can be treated with a daily Vitamin D supplement.

As we go through the Winter season, think about how much Vitamin D you’re getting from natural sunlight and if you might benefit from more time spent outside or from a supplement. You can always call us at 202.293.1000 to make an appointment at our office in Washington, DC, if you have questions about how a lack of Vitamin D might be affecting your sexual function.

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