His and Her Health

This is my first post to this message board. My wife has very low to no libido and mood swings. She has reluctantly read information I have found on the web and agreed to take a Saliva through the mail hormone test that tested Estradiol, Progesterone, Testosterone, and DHEA. We just received the results:<BR>Estradiol = 0.7 pg/mL<BR>Progesterone = 0.16 ng/mL<BR>Testosterone (Free) = 24.2 pg/mL<BR>DHEA = 450.0 pg/mL<P>She has been unwilling to talk to a doctor about about here lack of libido and mood swings, but has acknowledged them after talking to friends, etc. She is good health and is taking no drugs (birth control, antidepressants, etc.).<P>Can anyone help interpret these results? I understand a formal interpretation should come from a doctor, but it has taken a long time to take this first step. Any good web sources are very welcome also.<P><BR>Tim

I recommend you look up the profile for a poster on this board: distressed_12345 In his profile is a website (we aren't allowed to post it here) that has a page dedicated to lab work, including the methods, how to help you read it, etc.<P>Without knowing your wife's age, what methods were used to determine the results, and what the lab "normal" ranges are, it's not possible for anyone here to really help you interpret the results.<P>You may also want to consider reading a copy of the book "For Women Only," by the Drs. Berman, which covers some of these things.<p>[This message has been edited by dona1 (edited 16 September 2003).]

Thanks for the web site - it has info on bloodwork, but not saliva tests. There is a lot of info there I will look through.<P>I forgot to say my wife is 40, and the saliva was taken in the AM on day 21 of her cycle. All we got is a list of the results, and a list of ranges:<P>Estradiol 0.2 to 5.0<BR>Progesterone 0.1 to 0.5<BR>Testosterone 15 - 35<BR>DHEA 300 - 500<P><BR>

I only have a few minutes. I'll try to follow-up later.<P>Salivary tests are not as sensitive and accurate *from what I know* as blood tests. Free Testosterone is particularly difficult to measure.<P>However, lets assume your test results are accurate.<P>Lets also assume the ranges are correct.<P>(Both of these are HUGE assumptions. The tests could be poor sensitivity or accuracy and then the ranges are moot. The tests could be accurate and sensitive, but the ranges are wrong. Unless you have someone who knows what the "real" ranges should be, then it's moot too.)<P>Estrogen looks reasonable, given where she was in the cycle. (No expert here, just guessing.)<P>DHEA is a poor thing to measure. It's very variable. DHEAS is more stable, and a more reliable measure of what's actually going on. Thus this doesn't tell us much. It may be on average much higher or lower.<P>Progesterone looks reasonable too. The values for estrogen and progesterone should really have ranges for each of the phases of the cycle too, so the generic range is not very useful. (follicular, luteal, etc)<P>Free T: This value looks reasonable, given the assumptions above. However, note. The amounts of free T are VERY small. I'm *very* skeptical about the usefulness of salivary tests for measuring Free T or Total T values for women, esp those suspected of having low or extremely low values. *From what I know*, no salivary test has been reviewed in the literature for these conditions, thus it's hard to know if it's an appropriate diagnostic tool.<P>One would also want to check Thyroid, Prolactin.<P>I think you really need to find someone to do complete blood work. (You've seen the blood-work page, so you know what to ask for, and the assay methods, esp for Free/Total T) You should also try to find a provider who is willing to review these issues and is an expert in the field. I can probably help there too, just email me or post at that forum - we can't recommend providers here.<P>If you read the forum at the site listed in my profile, you will find numerous anecdotal stories about low T and potentially what effects it might have.<P>I also have scientific articles that you could read on this subject. You're welcome to, again, email me and I'll point you in the right direction.<P>Dona suggested books. I'll meet her one book and raise her two more.<P><UL TYPE=SQUARE><LI>I'm Not in the Mood: What Every Woman Should Know about Improving Her Libido, by Judith Reichman - Score, 9/10 <LI>For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life, by Jennifer Berman - Score 8/10 <LI>Resurrecting Sex: Resolving Sexual Problems and Rejuvenating Your Relationship by David Schnarch (One really doesn't need both of David Schnarch's books, but both are good and somewhat different. Resurrecting Sex discusses medical causes for sexual dysfunction, where Passionate Marriage only reviews the psychological, though it's an excellent book.)</UL><P>One other, perhaps. <BR> Please Understand Me II : Temperament Character Intelligence (Paperback, 1998)<BR>Author: David Keirsey<BR> <BR>Obviously, some of these are interested in exploring inter-relationship difficulties and such. I think you should consider these as part of the overall solution. Even if T is a strong factor, these can dramatically help you understand each other better and work together better. You'll probably need it. (Not that it's you or her, but this road can be long, frustrating and often like walking on broken glass - barefoot! All the help you can get will be a boost.)<P>Ok, I said I only had a bit of time, but now I've buried you. Hope this was helpful.<P>Finally, let me post the canned stuff, so you have it, and others might find it useful. I've not posted this in a while.<P> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>Before you post your first question, we thought we'd give you some pointers.<P>If you're asking about FSD issues, we need to know as much of the following as possible.<P><UL TYPE=SQUARE><LI>Age? <LI>Pre/Peri/Post Menapause?<LI>Birth Control (Type, length of time you've been taking it etc.)<LI>Any Sexual Abuse?<LI>Children<LI>Medications (Birth-control, Anti-depressants etc)<LI>Spouse/Partner Relationship Health?<LI>History of the FSD issue, pre and post FSD if possible.<LI>What things you've tried.<LI>What you *think* might be the problem.<LI>Blood hormone levels done? Give us the results and norm ranges from the tests. (Make sure you get a full copy of all results and norm ranges.) </UL><P></font><HR></BLOCKQUOTE><P>Some excellent books on the subject.<BR> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR><UL TYPE=SQUARE><LI>I'm Not in the Mood: What Every Woman Should Know about Improving Her Libido, by Judith Reichman - Score, 9/10 <LI>For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life, by Jennifer Berman - Score 8/10 <LI>Hot Monogamy: Essential Steps to More Passionate, Intimate Lovemaking, by Patricia Love - Score 7/10 <LI>Resurrecting Sex: Resolving Sexual Problems and Rejuvenating Your Relationship by David Schnarch (One really doesn't need both of David Schnarch's books, but both are good and somewhat different. Resurrecting Sex discusses medical causes for sexual dysfunction, where Passionate Marriage only reviews the psychological, though it's an excellent book.)<LI>Passionate Marriage: Love, Sex, and Intimacy in Emotionally Committed Relationships, by David Schnarch - Score 8/10 <LI>Natural Hormone Balance for Women: Look Younger, Feel Stronger, and Live Life with Exuberance by Uzzi Reiss - Score N/A <LI>The Hormone of Desire :the truth about sexuality, menopause, and testosterone by Susan Rako - Score N/A (Older book, Copyright 1996) <LI>The Big O: Orgasms: How to Have Them, Give Them, and Keep Them Coming by Lou Paget - Score N/A <LI>Getting the Sex You Want, a Woman's Guide to Becoming Proud, Passionate, and Pleased in Bed by Sandra Leiblum, Ph.D. and Judith Sachs. </UL><BR></font><HR></BLOCKQUOTE><P>And last, some detailed info on blood-work. Again, I know you've seen some of this, but thought I'd post again for you and perhaps others.<P> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>First thing. <P>Call every doc who has run *any* blood work on you for the last couple of years. Request that they either mail, fax, carrier pidgeon, etc *FULL* copies of all results to you. This is really important, and something that you should ask for in the future. <P>(Don't accept *only* a "reading" over the phone, though I'd take careful notes if they offer. Then ask for them to mail or fax. If they refuse, politely inform them that you are legally entitled to full copies of your medical records, and that they need to get with the program.)<P>Post those results here, along with the ranges they give as "Normal."<P><BR>Probably the most important test(s) in relation to desire disorder/ low libido, arousal disorder and sensation issues are:<P><UL TYPE=SQUARE><LI>Total and Free T by equilibrium dialysis if possible (see an explanation of this in the blood-work section of the website listed in my profile.)<LI>Thyroid Function Tests (TSH, Thyroxine/T4)<LI>Prolactin / PRL (A blood test that measures the amount of the hormone prolactin.)<LI>LH / ICSH (Luteinizing hormone) <LI>FSH (Follicle Stimulating Hormone)<LI>Estradiol<LI>SHBG (Sex Hormone Binding Globulin)<LI>DHEA and DHEAS</UL><P>There are some additional issues, if you've not had your tests done yet.<P>Get your Total and Free T levels measured with a test called "equilibrium dialysis." The only other reliable method we recommend is the Free Androgen Index, sometimes also called the Free Testosterone Index, which is the index of Total T/SHBG. This issue is incredibly important. (The cheapest and most widely used test is RIA. RIA is *completely* unreliable to measure T levels in women, especially those levels found in women with very low testosterone. In fact, the FDA is currently working to either force the makers of the RIA tests to show its accuracy in women, or forbid their use in women.)<P>Have your blood drawn in the morning hours, and during the middle third of your cycle, about days 8-15. (This piece is probably not of immense importance, though it currently is thought to give the most accurate picture of your T levels. The monthly cycle doesn't apply to those on hormonal birth control since you're not ovulating. Post-menopausal women don't generally have to worry about either, it appears, and thus blood can be drawn anytime.)<P>The assay methods for all the other tests are generally just fine. <P>The problem with Free T, is the extremely low levels in women. Accurately determining Free T levels, especially at the lower end of the normal range, much less those below the range are very difficult. Equilibrium dialysis is to our knowledge the only assay that can properly determine Free T values over the whole range. <P><B>Notes on the FAI.</B><BR>The Free Androgen Index is calculated by taking Total Testosterone in noml/L and dividing by SHBG in nmol/L<BR>(Total T nmol/L / SHBG in nmol/L)<P>Total T is not often given in nmol/L, but ng/dl. To convert to nmol/L, multiply the value in ng/dL by 3.467.<P><B>Example:</B> Total T of 10ng/dL = 353.634 nmol/L.<BR>If SHBG was 80 nmol, the FAI would be 0.4333.<P>Obviously, working with a good provider will be essential to finding the proper treatment approach for each person. This information should not be used as a substitute for working with a provider who is knowledgeable and capable of treating your issues. <P><BR>Sources:<BR>---<BR>FERTILITY AND STERILITY<BR>VOL. 77, NO. 4, APRIL 2002 (Entire supplement.)[/b]<BR></font><HR></BLOCKQUOTE><P>Sorry for the length.<P>Ask if you have questions or follow-up. I've been ultra busy of late, and have had difficulty staying on top of things as well as I'd like.<P>Best wishes. I know where you're starting from. I was there about a year ago, and we still have many things to work out. We are light-years away from where we were - to the better, but still not "there" yet. (Though, life is always a journey. You're never "there.")<P>You are in our thoughts.<BR>Greg<P>------------------<BR>Also note, I am *not* a doctor, and this is not intended as medical advice - Please talk to your doctor about your concerns.<P>[This message has been edited by distressed_12345 (edited 17 September 2003).]<BR><p>[Note: This message has been edited by NEWSHE Moderator]

Thanks for the info Greg. The ranges in my reply above (I'll repeat below) for Estradiol & Progesterone were for the luteal phase.<P>Estradiol 0.2 to 5.0<BR>Progesterone 0.1 to 0.5<BR>Testosterone 15 - 35<BR>DHEA optimal range 300 - 500 (Reference range 80 - 400)<P>There were 2 columns of ranges - Reference Range and Optimal Range. The ranges were identical except for the DHEA, which had different values. There was also a note stating "PM concentrations of Testosterone and DHEA can be significantly lower than AM concentrations". My wife's sample was taken in the AM.<P>I wasn't sure how to interpret a value that falls in the low end of the range, but is still "in the range" (Estradiol & Progesterone).<P>I'll have her read your post and check out the web site. <P>Tim<P>

Tim,<P>Mood swings and diminished libido are common symptoms of depression. I would consider this as a strong possibility.<P>Greg,<P>It would be very helpful to many if you would summarize the main idea in the David Keirsey book you recommended, "Please Understand Me II: Temperament, Character, Intelligence". What is the main point the author makes? I feel it's an excellent one and it would be helpful to many if you would share what you've learned from the book.<P>

Mood swings and lack of desire (which is actually a secondary effect of things like fatigue, depression, etc.) can also be caused by low estrogen. Many docs overlook this, and will try to treat the depression rather than the estrogen deficiency. It can happen at any age, as I am finding out. I am 31 and entering perimenopause. Some women never have adequate estrogen levels.<P>Has your wife always had a low libido and mood swings? If not, when did it begin? If yes, has she had her estrogen tested?<P>It may or may not be the cause, but it's worth looking into. It's also something that you can consider correcting fairly naturally if it's not really severe, simply by increasing her phytoestrogen intake by eating things like soy. Before you do this, though, get the levels tested. Estrogen can decrease free Testosterone, so make sure what the problem is before you start treating it.<P>Owner also has a good point about depression itself being the cause of things similar symptoms. Other things that can cause these symptoms include stress, fatigue, diabetes, thyroid issues, relationship difficulties (see stress), ovulation and ovarian issues (she is seeing a gyn for annual exams, isn't she?), and a variety of other things. Does she have regular physicals and gyn exams? Has she ever had a full blood panel done to test for chronic conditions? Things like diabetes aren't always obvious, esp. if they aren't yet severe. Mood swings can be triggered by simple blood sugar levels in that case. <P>It's worth taking the time to ask some serious questions, which may help get you going in the right direction:<P>1) What do you mean by "low libido?" <BR>2) Does your wife enjoy sex once she gets started?<BR>3) Has she always had a "low libido?"<BR>4) Does she experience any pain or discomfort during sex?<BR>5) Is there adequate foreplay time?<BR>6) Has she ever been tested for common physical ailments that can cause her symptoms?<BR>7) Does she have other physical symptoms? Sometimes these aren't really apparent unless you sit down and think about it--fatigue, thirst, etc.?<BR> Does she eat right, take a multi-vitamin, get plenty of sleep and fluids?<BR>9) Is your relationship, bedroom issues aside, healthy and fulfilling for her?<BR>10) Does she have other symtoms of depression, bi-polar disorder or mania?<BR>11) Does she have any sexual trauma or upbringing issues in her past (i.e., sex is dirty?)?<P><BR>Narrowing down some the possiblities should help the two get started down the right path. Pinpointing when the symptoms started can really help, as sometimes there are correlations that don't come to light until it's really thought out (ex: I had knee surgery and lost my ability to orgasm for about 4 months, at which time my libido also went completely away--I didn't realize that was the problem until I sat down and figured out that it was a surgery-related issue that eventually went away with time).<P>Hope this helps a bit.

Thanks to all who have replied. <P>I'll attempt to answer's to Dona1's questions:<P>1. By low libido I mean low desire - tough to get her in the mood.<P>2. Most of the time she enjoys sex once she gets started.<P>3. She has always had a low libido, but it's dropped a lot over the last 3 - 5 years.<P>4. She has never complained about pain or discomfort during sex.<P>5. There is adequate foreplay time, although she doesn't like much foreplay time.<P>6. She does have annual obgyn exams, but won't ask about the low libido. She did inquire about hormone testing during her last visit, the doctor said she was too young (40). My wife didn't push the issue. This is why we did the Saliva test through the mail.<P>7. She does have ulcerated colitis, but it has been under control for at least 6 years. Even when the colitis was acting up, her mood swings and libido weren't effected either way.<P>8. She eats well, takes vitamins, exercises, and gets enough sleep.<P>9. We have a pretty good relationship. She has told me she is happy. We have our differences once in a while (doesn't everyone?), but I think both of us are constantly learning more about each other.<P>10. I can't completely rule out mental issues, but she is not bipolar. I guess mood swings can be a sign of depression, but she doesn't seem to be depressed. I guess this is one to think more about.<P>11. I don't think there is any sexual trauma issue. She has never said the thinks sex is dirty.<P>The mood swings and low libido have been there as long as I can remember (we've been married 13 years), but have gotten worse over the last few years. The mood swings are definitely worse before her period, but sometimes they come out of the blue.<P>When you say low estrogen, do you mean from a blood test? Any particular estrogen hormone (estradiol, etc.). I thought the results of the saliva test showed estradiol on the low end of the range, but is in range OK? Or was this saliva test not worth doing in the first place?<P>My thinking was the saliva test was a place to start that was not invasive and did not require talking to a doctor ahead of time.<P>I'll re-read the above replies and see if my wife and I can come up with a game plan.<P>Tim<P>

reb,<P>Although estrogen replacement can make sexual activity physically more comfortable and pleasurable, it generally has little lasting effect on sexual desire or mood. There are methodology flaws in most of the studies and inconsistency of results so it's been difficult to assess. Estrogen is known to increase well-being during the first month of treatment in perimenopausal women. It's thought to be due to reduction of vasomotor symptoms and sleep disturbances. There is a body of literature suggesting that any association found between menopause and mood or depression is most likely to be explained by other factors, such as vasomotor symptoms and sleep problems. This highlights the importance of studying the complex relationship between hormone levels, sleep problems and vasomotor symptoms during the menopausal transition.<P>It is now believed by some that a HIGH estrogen (not low estrogen) to progesterone ratio may affect mood negatively. Estrogen treatment in PMS has been found to worsen mood during the luteal phase. In short, it's my opinion that "low estrogen" is likely not the issue, but I suppose there's no harm in investigating it further.<P>I too would recommend the book, "I'm Not in the Mood: What Every Woman Should Know About Improving Her Libido" by Judith Reichman, for your wife to read: "The book has had the beneficial effect that most of my patients are able to honestly reveal if there is marital discord that may not have been admitted to in the first appointment. Opening up the way for a sex therapist or marriage counselor has been another positive benefit of this book. I find that many of my patients were reluctant to consider counseling in the first appointment, but were willing to include counseling as part of the treatment plan of their decreased libido. So many women learn about the female body and functions for the first time while reading this book. Every patient has been very happy with this book and no longer felt alone with this problem. They were able to realize that other women have suffered with this same problem and that, most of the time, there is positive results with hormones, exercise, honest communication with their spouse, counseling and/or treatment for depression."<P>It also sounds like this has been her personality since you met her. David Keirsey's, "Please Understand Me II: Temperament, Character, Intelligence" might be helpful. Sometimes it's important to recognize we usually can't change someone else's temperament or personality to suit our desires. But we can learn how to appreciate our differences.<P>Tim, I'm sure you already are aware of the associations that have been made between psychological/personality traits (anxiety, neurotisicm, introversion, for example) and ulcerative colitis. I have a dear friend who has ulcerative colitis, so I know some about being close to someone in this situation. It's somewhat of a chicken or egg question, but I do know from talking with his mother that he was literally born with his temperament. He's made great strides in dealing with his psychological obstacles. I learned from my relationship with him that I can't tell someone to think or behave a certain way. I can't tell you how enormously proud I am of his success in life, but that's another story for a different message board.<p>[This message has been edited by Owner (edited 20 September 2003).]

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2">Originally posted by dona1:<BR><B>ex: I had knee surgery and lost my ability to orgasm for about 4 months, at which time my libido also went completely away</B></font><HR></BLOCKQUOTE><P>Hi Dona,<P>Just curious - did you ever figure out how knee surgery affected your ability to orgasm??<P>Thanks.<P>

Mavis--I had a spinal block while under the anesthesia. I know it had affected overall feeling, and had been it warned it would do so. This was part of the pain management. I didn't have any feeling at intermally from my pelvis to below my knee for several days after teh surgery (yes, this made going to the bathroom both unpredictable and uncontrollable, but they'd prepared me for how to deal with this), then it returned slowly over the next several weeks to a point that seemed fairly normal. Sexual function, apparently, didn't return as quickly. It actually took several months for me to recover feeling sufficiently to orgasm again. This can happen to men, as well, who have certain types of surgery; but, it's more obvious becaue it effects erectile ability.

Hi Dona,<P>It's interesting that orgasmic function returned later than sensation. I didn't know that would happen. Thanks for the reply.

mavis--it wasn't that function returned after feeling, it's that it took that long for enough feeling to get to the point of orgam.

ok gotcha now, thanks<BR>