Dear Doctor Dean,
I am a 58-year-old woman who eats really well and exercises 5 days a week at a gym with weights cardio and ab exercises, for about nine years. I have just finished an education degree and teach a couple of days per week.
I see an anti-aging doctor in Melbourne and take Estradiol/estriol 50:50 6 MG BI Gel daily with 0.5 /ML testosterone. Progesterone 200 mg capsules in the evening 25 days of the month with a rest of 5 days per month. I have been taking this for about 8 years.
I take Metformin 500 mg tablets twice a day and for the past 4 months have been taking an antidepressant called Lovan 20 tab I per day. In 2000 I had half my thyroid removed because of tumours and have been swallowing thyroxine sodium tablets 100 mcg per day ever since. I have blood tests and they are fine. I feel healthy and I am in good spirits and generally look years younger and stronger than anyone I know in my age group. However, I have one major problem.
I have the “org” but not the “gasm.” It’s like my little button has switched itself off. Can you shed some light on this? I have read IAS articles. Would Russian peptides help me? If so, which ones specifically? Or should I try oxytocin?
I respect you so very much, Dr. Dean. Perhaps when I teach in America I could see you for an appointment. Until then, have you some idea of where I should be looking to overcome this hormone imbalance?
First, I noted that you are not supplementing with either DHEA or Pregnenolone — both of which decline dramatically with age.
However, your physician is inexplicably prescribing testosterone for you —which will preclude your taking DHEA, because women very efficiently convert DHEA into testosterone. Taking both testosterone and DHEA would probably really throw you out of balance. I rarely prescribe testosterone to women, because they can almost always restore testosterone to youthful levels by taking DHEA. DHEA by itself, is a well-documented mood elevator. (1) I suggest you discontinue testosterone, and start taking DHEA — for women, 25 mg is usually enough (although you may need to adjust it slightly up or down), first thing in the morning.
Also, Pregnenolone is another often-overlooked hormone that declines with age, and which converts preferentially to progesterone, and also to DHEA.
Notwithstanding, the most likely cause of your anorgasmia may be your anti-depressant. Lovan (aka, Prozac, fluoxetine) is a well-known cause of sexual dysfunction and loss of libido.
I suggest weaning yourself from Lovan, and switching to 5-HTP, 150-300 mg per day at bedtime on an empty stomach. (2,3) 5-HTP is a precursor of serotonin, and usually produces equal benefits of the SSRIs, without the adverse effects.
Also, you might consider Deprenyl, which has been best known as an “anti-aging, life-extending aphrodisiac.” (4-7) Although most of the studies of the aphrodisiac effects of deprenyl have been conducted on male rats, the effect has generally been attributed to its MAO-B inhibiting effect, which is shared equally by both sexes. Another possible cause of deprenyl’s aphrodisiac effect may be to its less well-known ability to raise serum levels of Nitric Oxide (8,9) —to which the effects of Viagra and Cialis are attributed.
Deprenyl has also been shown to be an effective antidepressant, which you may find of additional benefit. (10-17) Prof. Josef Knoll recommends those of us who are over 45 take 10-15 mg Deprenyl per week (about 2 mg/day) for its anti-aging, neuroprotective effects.18
Oxytocin, as you suggested, may also help, but I like to try the cheap stuff first.
Ward Dean, MD
1. Barrett-Connor E., Von Muhle, D, Laughlin G, Kripke A. Endogenous levels of dehydroepiandrosterone sulfate, but not other sex hormones, are associated with depressed mood in older women. The Rancho Bernardo Study. J am Geriatr Soc 1999, 47(6), 685-691.
2. Byerley W, et al. 5-Hydroxytryptophan: A Review of Its Antidepressant Efficacy and Adverse Effects. J Clin Psychopharmacol 1987; 7: 127-37.
3. Poeldinger W, et al. A Functional-Dimensional Approach to Depression: Serotonin Deficiency as a Target Syndrome in a Comparison of 5 -Hydroxytryptophan and Fluvoxamine. Psychopathology. 1991; 24: 53-81.
4. Yen TT, Dalló J, Knoll J. The aphrodisiac effect of low doses of deprenyl in male rats. Pol J Pharmacol Pharm. 1982 Nov-Dec;34(5-6):303-8.
5. Knoll J, Yen TT, Dallo J. Long-lasting, true aphrodisiac effect of (-)-deprenyl in sexually sluggish old male rats. Mod Probl Pharmacopsychiatry. 1983;19:135-53.
6. Dalló J, Yen TT, Knoll J. The aphrodisiac effect of deprenyl in male rats. Acta Physiol Hung. 1990;75 Suppl:75-6.
7. Ruehl WW, Entriken TL, Muggenburg BA, Bruyette DS, Griffith WC, Hahn FF. Treatment with L-deprenyl prolongs life in elderly dogs. Life Sci. 1997;61(11):1037-44.
8. Thomas T, McLendon C, Thomas G. L-Deprenyl: nitric oxide production and dilation of cerebral blood vessels. Neuroreport. 1998 Aug 3;9(11):2595-600.
9. Thomas T. Monoamine oxidase-B inhibitors in the treatment of Alzheimer’s disease. Neurobiol Aging. 2000 Mar-Apr;21(2):343-8.
10. Lee KC, Chen JJ. Transdermal selegiline for the treatment of major depressive disorder. Neuropsychiatr Dis Treat. 2007;3(5):527-37.
11. Feiger AD, Rickels K, Rynn MA, Zimbroff DL, Robinson DS. Selegiline transdermal system for the treatment of major depressive disorder: an 8-week, double-blind, placebo-controlled, flexible-dose titration trial. J Clin Psychiatry. 2006 Sep;67(9):1354-61.
12. Amsterdam JD. A double-blind, placebo-controlled trial of the safety and efficacy of selegiline transdermal system without dietary restrictions in patients with major depressive disorder. J Clin Psychiatry. 2003 Feb;64(2):208-14.
13. Higuchi H, Kamata M, Sugawara Y, Yoshida K. Remarkable effect of selegiline (L-deprenyl), a selective monoamine oxidase type-B inhibitor, in a patient with severe refractory depression: a case report. Clin Neuropharmacol. 2005 Jul-Aug;28(4):191-2.
14. Amsterdam JD, Bodkin JA. Selegiline transdermal system in the prevention of relapse of major depressive disorder: a 52-week, double-blind, placebo-substitution, parallel-group clinical trial. J Clin Psychopharmacol. 2006 Dec;26(6):579-86
15. Sunderland T, Cohen RM, Molchan S, Lawlor BA, Mellow AM, Newhouse PA, Tariot PN, Mueller EA, Murphy DL. High-dose selegiline in treatment-resistant older depressive patients. Arch Gen Psychiatry. 1994 Aug;51(8):607-15.
16. Kitaichi Y, Inoue T, Mitsui N, Nakagawa S, Kameyama R, Hayashishita Y, Shiga T, Kusumi I, Koyama T. Selegiline remarkably improved stage 5 treatment-resistant major depressive disorder: a case report. Neuropsychiatr Dis Treat. 2013;9:1591-4. doi: 10.2147/NDT.S49261.
17. Higuchi H, Kamata M, Sugawara Y, Yoshida K. Remarkable effect of selegiline (L-deprenyl), a selective monoamine oxidase type-B inhibitor, in a patient with severe refractory depression: a case report. Clin Neuropharmacol. 2005 Jul-Aug;28(4):191-2.
18. Knoll J. Deprenyl-medication: a strategy to modulate the age-related decline of the striatal dopaminergic system. J Am Geriatr Soc. 1992 Aug;40(8):839-47.