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Tip sheet for the Annals of Internal Medicine, April 15, 2008, issue

1. Testosterone Spray Improves Sexual Satisfaction Slightly in Premenopausal Women But So Does Placebo; Editorial Says Treat Women Conventionally

A study that randomized 261 women aged 35 to 46 with self-reported low libido and low serum free testosterone levels to a group that received one of three different doses of a testosterone spray or placebo daily for 16 weeks found that all groups -- including those taking placebo--reported increased frequency of sexually satisfying events (Article, p. 569).

The difference between testosterone spray and placebo was statistically significant only for the middle dose of testosterone.

Overall, 81 percent to 86 percent of women in the active treatment groups and 70 percent of the women in the placebo group reported adverse events. The most common event in the treatment group was hair growth on the abdomen, where the testosterone was sprayed.

An editorial writer says that just because testosterone levels and womens libidos may decline as women age does not mean that lack of testosterone explains sexual dissatisfaction (Editorial, p. 620).

We do not have a fully satisfactory rationale for testosterone therapy, the writer says, and there is also a lack of long-term safety data. Rather than prescribe testosterone, the writer advises primary physicians to address womens mental health and relationship issues, sexual dysfunction in the partner and treat problems by conventional therapy, such as cognitive behavioral therapy, sex therapy, and psychotherapy.

2. Risks and Benefits of Buying Prescription Drugs from Foreign Countries

Buying imported prescription drugs is legal in some cases, but even when the drug is cheaper than a U.S. brand-name drug, it may not be a wise purchase, say authors of a paper on the international pharmaceutical market as a source of low-cost prescription drugs for U.S. patients (Medicine and Public Issues, p. 614).

Authors posit four guidelines for patients, physicians and policymakers for importation of prescription drugs.

However, the safest way to control U.S. drug prices is by promoting consumer demand for and appropriate prescription of domestic generic drugs, they say.

3. Comprehensive Strategy Needed to Control Gonorrhea Epidemic

Incidence of Neisseria gonorrhoeae in the United States declined markedly from 1975 to 1997 and has remained relatively stable over the past decade at about 120.9 cases per 100,000 population (Perspective, p. 606).

However, rates of gonorrhea remain high in the South and among African Americans, adolescents, young adults, and men who have sex with men, and infection rates are rising. Further, the disease has serous implications for reproductive health and health costs; and treatment options have narrowed as gonorrhea has become resistant to many drugs; (currently, gonorrhea treatment options come from a single class of antimicrobials -- cephalosporins).

Authors say that in addition to developing and providing effective antimicrobial drugs, a comprehensive program to control gonorrhea must include screening people at risk for infection, surveillance for resistance, secondary screening and treatment of sex partners, and stimulating investment into research for new antimicrobials.


Contact: Susan Anderson
American College of Physicians

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