Topic
Hormones and dopamine for HSDD
I am a 53 year-old woman, new found friend of a wonderful and generous patient who has already been treated for female sexual dysfunction. She encouraged me to seek treatment
I am in a monogamous same sex relationship for 25 years. i have low, non-existent sexual interest, poor lubrication and arousal, difficulty reaching a muted form of orgasm and discomfort during sexual penetration. I have had panic and anxiety issues in the past and was started on antidepressant SSRIs 13 years ago. I am now off the antidepressants but may have PSSD – post SSRI sexual dysfunction. Also all my sexual problems have been worsened by menopause that started last year. Currently, desire has been non-existent. Currently my interest, arousal and orgasm are 0%, 10% and 10% that of previous capabilities, respectively. I also have have sexual discomfort located in the vaginal area for two years, triggered by penetration; and made better by removal.
I underwent testing and was found to have moderate loss of feeling in the vaginal opening area. During physical examination with a vulvoscope, i had mild clitoral atrophy, 40% labial resorption, significant provoked vestibulodynia or vulvar vestibulitis syndrome, mild vaginal atrophy, and abnormal vaginal pH. Hormone testing revealed a dihydrotestosterone and testosteorne in the lowest tertile, a low progesterone, a low estradiol and elevated gonadotropins LH and FSH values consistent with menopause.
Based on my physical findings of mild clitoral atrophy and provoked vestibulodynia and low dihydrotestosterone, I was told I had low testosterone and symptoms consistent with low testosterone. I was told I had the following options for testosterone therapy. This included intramuscular injections weekly into the thigh, daily topical gel and a subcutaneous pellet every 4-6 months. I selected the subcutaneous testosterone pellet and one was inserted without much discomfort.
Based on my physical finding of labial resorption, vaginal atrophy, abnnormal vaginal pH, provoked vestibulodynia, and low estradiol, I was told I had low estradiol and symptoms consistent with low estradiol, I chose to be treated with systemic biologically identical estradiol replacement – Vivelle dot 0.05 mg twice a week.
Based on low progesterone blood tests, i chose progesterone treatment with 2 times per week administration of prometrium (100 mg), a biologically identical progesterone, on Monday and Thursday. Concerning significant signs of labial resorption, i also chose to place local estradiol cream to my labia minora. Concerning mild vaginal atrophy, and abnormal vaginal pH, i chose to consider every other day low dose biologically identical estradiol to the vagina. Concerning low sexual interest and orgasm dysfunction, I now use cabergoline on Monday and Thursday to raise dopamine (a sexual function facilitator).
I am happy to announce that after just THREE weeks of these treatments, I am feeling better and better. My energy has stayed higher and my vaginal tissues feel thicker. When having sex with my partner, I am physiologically responding. I now have faster engorgement of my vaginal tissues including my clitoris. My libido is sputtering and that is an improvement. I still do not respond to visual stimuli. Also I am reaching orgasm somewhat sooner, but it is still muffled at best. I just started the 0.5mg dose of cabergoline last evening, to be taken twice a week, and I have not noticed any disagreeable side effects. One side effect that must be related to the cabergoline though is hypotension. I have been taking Tenormin 50mg daily for years to control my BP. Since starting cabergoline my systolic BP has gone down to 90-100 (usually is 120-140). I cut the dose in half while on 0.25mg cabegoline twice a week; and decided to not take Tenormin at all today-my BP today is normal, my HR is normal. One issue I had last week was that in stressful situations, my HR increased uncomfortably – usually Tenormin suppresses that response.
So that’s my current story. Currently I am taking Vivelle 0.05 twice a week, Estrace topically at nights, Vagifem 10 mcg every other night, Cabergoline 0.5 mg twice a week, Prometrium 100 mg twice a week, Prilosec 20mg daily, Clonazepam 3mg daily, Wellbutrin XL 150mg each morning.