Testosterone and Vaginal Function

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Testosterone and Vaginal Function
Elisa Maseroli , Linda Vignozzi


Abstract

Introduction: Androgens have been shown to exert beneficial effects on vaginal physiology, at least partially independent of their aromatization to estrogens. Androgen deficiency in the vagina and in the other genitourinary tissues contributes to the development of vulvovaginal atrophy and genitourinary syndrome of menopause, resulting in impaired arousal and lubrication, and dyspareunia.

Objectives: To summarize the role of testosterone in modulating vaginal structure and function.

Methods: A qualitative review of the relevant literature on the topic was performed using the PubMed database. We present a summary of preclinical and clinical evidence supporting the involvement of testosterone (T) in vaginal physiopathology and discuss it in terms of the role of the vagina in female sexual response.

Results: Androgens are important in the differentiation of the vagina and in maintaining trophic and functional actions in postnatal life, as suggested by the detection of the androgen receptor and of the key enzymes involved in androgen synthesis. T is essential for the integrity of vaginal tissue structure (including non-vascular smooth muscle thickness and contractility and collagen fiber compactness) and for the complex neurovascular processes that regulate arousal and lubrication (vascular smooth muscle relaxation via the NO/cGMP/PDE5 pathway, nerve fiber density, and neurotransmission). T has also been reported to modulate nociception, inflammation, and mucin secretion within the vagina. Available and potential androgen-based treatments for vulvovaginal atrophy/genitourinary syndrome of menopause and for other conditions leading to female genital arousal disorder and dyspareunia are presented.

Conclusions: The vagina is both an androgen-target and synthesis organ. Preclinical and clinical data consistently suggest that T plays an important role in maintaining vaginal health and genital sexual function.
 

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Defy Medical TRT clinic doctor
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Figure 1. Androgen receptor immunohistochemistry of human fetal female reproductive tracts. Panel A shows the low-power overview sagittal section. Note AR staining in mesenchyme associated with the vaginal plate and vagina. Panel B shows a higher magnification view of the vaginal region showing mesenchymal AR staining. Panel C shows the Absence of AR staining in the uterine corpus ([A] and [C]). Panel D shows intense mesenchymal AR staining associated with the junction of the cervix and vagina. Panel E shows the uterine tube of a 16-week fetus showing strong AR immunoreactivity. AR ¼ androgen receptor. Reproduced with permission from the study by Cunha et al.20 Figure 1 is available in color online at www.jsm.jsexmed.org.
 
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Figure 2. Synthesis of the main sex steroids in women. DHEA is the major androgen secreted by the adrenals. Testosterone is formed from cholesterol in the ovaries and adrenals and from circulating DHEA in the peripheral tissues, including the vagina. Estradiol and estrone derive from precursor testosterone and androstenedione, respectively, and are a minor product of the adrenal glands. 5a-DHT is synthesized from testosterone in target tissues by 5a-reductase (SDR5A). CYP ¼ cytochrome P450; DHEA ¼ dehydroepiandrosterone; DHT ¼ dihydrotestosterone; HSD ¼ hydroxysteroid dehydrogenase; SDR¼ short-chain dehydrogenase/reductase; StAR ¼ steroidogenic acute regulatory protein
 
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Figure 3. Potential mechanisms of regulation of vaginal function in the context of the female sexual response. AR ¼ androgen receptor. NO/cGMP/PDE5 ¼ nitric oxide synthase/cyclic guanosine monophosphate/phosphodiesterase-5. Figure 3 is available in color online at www. jsm.jsexmed.org.
 
Table 1. Available and off-label local and systemic androgen-based therapies for the treatment of VVA/GSM and related sexual dysfunction
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I remember seeing this product on Empower’s site. Looks like several versions have 1mg/ml T in the mix.

Arousal 1: Aminophylline 30 mg/mL, Ergoloid Mesylate 0.5 mg/mL, Pentoxifylline 50 mg/mL, Sildenafil Citrate 10 mg/mL, Testosterone 1 mg/mL, L-Arginine 60 mg/mL 30 mL Topi-Click Dispenser

Arousal 2: Aminophylline 30 mg/mL, Ergoloid Mesylate 0.5 mg/mL, Pentoxifylline 50 mg/mL, Sildenafil Citrate 10 mg/mL, Testosterone 1 mg/mL 30 mL Topi-Click Dispenser

Arousal 3: Aminophylline 30 mg/mL, Ergoloid Mesylate 0.5 mg/mL, Pentoxifylline 50 mg/mL, Testosterone 1 mg/mL, L-Arginine 60 mg/mL 30 mL Topi-Click Dispenser

Arousal 4: Aminophylline 30 mg/mL, Ergoloid Mesylate 0.5 mg/mL, Pentoxifylline 50 mg/mL, Sildenafil Citrate 10 mg/mL, L-Arginine 60 mg/mL 30 mL Topi-Click Dispenser

Arousal 5: Aminophylline 30 mg/mL, Ergoloid Mesylate 0.5 mg/mL, Pentoxifylline 50 mg/mL, Sildenafil Citrate 10 mg/mL 30 mL Topi-Click Dispenser
 
Stupid question, but would this require the wifey to go through same protocol and expense as HRT for men With Defy? Meaning full blood work, doc appointment, etc?
 
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