Dr. Sarrel shares if there is an FDA-approved synthetic testosterone available?
Well, first, of course, is that there are the generic substitutes for Estratest®, and there again, if someone is given that, they need to know that it’s working, and they are not getting too much or too little.
We also have the male products which can be adapted for female use, and some doctors do that, but it’s very complicated to do. And remember that those male patches have ten times as much testosterone as a woman would ordinarily be using if the female patch was available.
We have injections. We have implants. I have already discussed that, but there’s one big subject that needs to be brought into our discussion, and that is bioidentical preparations which contain testosterone. The issue here is first, that it’s not being monitored by the FDA, so there’s always the quality control issue.
How much is in that cream? Is it too much, too little? Is it going to work or not?
Because the creams are applied externally, a woman typically would take, squeeze out of her tube of two percent testosterone cream she would squeeze out enough that would cover a toothbrush, like a tiny bit, and rub that on her external genital organs, her clitoris and her small lips. And she is thinking, “Well, it’s only going to work there and increase my sensitivity,” but in fact it’s rapidly absorbed into the body.
So with the two percent cream you do have to watch for the same problem of too little or too much and an excessive reaction, an adverse reaction to the local application. Should all women be given it? Because there are bioidentical preparations which contain three different estrogens, progesterone and testosterone, which to me is totally crazy because there are no studies of the interaction of these hormones when they are all taken at once. There are no studies of how safe they are, how effective they are.
The irony is that saliva testing is used to see what hormone levels are established by this combination of all these hormones, and salivary testing is very unreliable unless you get multiple samples during the course of a day, which no one is going to do to get a single salivary test.
I feel that this is one of the detrimental effects of the Women’s Health Initiative, and that is been that women have been driven to find other sources of hormonal treatment that are being touted as safer because they are natural hormones, when in fact there are no studies to show what they are getting, how safe they are, the testing that’s being used is been deemed to be not reliable.
Our own studies of salivary testing compared to blood level show no correlation between the two. So a bad effect of the Women’s Health Initiative has been that women receiving hormone therapy, including testosterone therapy, are subjects of another kind of abuse, and that has been the treatment with products that we don’t know much about. And the FDA has taken steps recently to get those laboratories to stop making those products. How successful they have been, nobody really knows.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.