AASECT How Hormones & Neurotransmitters Impact Sexual Function

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How Hormones & Neurotransmitters Impact Sexual Function: Coordinating Testing, Evaluation & Treatment Methods Between Medical & Non-Medical Practitioners - AASECT Annual Conference 2011

AASECT How Hormones & Neurotransmitters Impact Sexual Function

  1. 1. How Hormones and Neurotransmitters Impact Sexual Function: <ul>Mark Kim Malan PhD, MPH, DACS <li>Colette Malan MSW, LCSW
  2. 2. AASECT Annual Conference 2011
  3. 3. Copyright 2011 Additional material used by permission and fair use </li></ul>Coordinating Evaluation, Testing & Treatment Methods between Medical and Non-Medical Practitioners
  4. 4. Speakers Disclosure: We have no financial relationships or affiliations to disclose.
  5. 5. Our target audience (Are you at the right presentation?) <ul><li>Non-medically trained sexologists, educators, counselors, therapists, & researchers
  6. 6. Medically trained providers who wish to coordinate patient care with non-medical sexual health providers (physician & therapist)
  7. 7. Want a basic understanding of hormones & neurotransmitters that impact sexuality
  8. 8. Want to know basics about hormonal lab tests </li></ul>
  9. 9. Need for Multidisciplinary Sexuality Health Care <ul>“...the challenge sexual medicine is facing today is... to blend together a 'medicine without a soul' which pays little attention to the emotions, concerns, and affective dynamics associated with medical illnesses, and a 'psychology without a body' , which still under appreciates the neurobiologic basis for any feeling, memory, emotion or thought”. Graziottin, A. (2006). Introduction to female sexual disorders. In Porst, H. & Buvat, J. (eds), Standard Practice in Sexual Medicine, p. 287, Blackwell, Malden, MA. </ul>
  10. 10. Our goal – Meet that need <ul><li>Our daily clinical experience involves coordinating our clinical sexology, sex therapy & psychotherapy practice with OB/GYN's, urologists, endocrinologists, compounding pharmacists, and other medical specialists.
  11. 11. Often these professionals tell us they lack specific training in sexual side effects of drugs, hormonal imbalance & treating sexual problems.
  12. 12. Knowing about drug side effects, hormones, neurotransmitters and lab tests is essential in coordinating our patient care with these providers. </li></ul>
  13. 13. <ul>What this presentation provides: </ul><ul><li>Assumes no prior knowledge of hormones
  14. 14. A basic overview and introduction to hormones & neurotransmitters
  15. 15. Basics of how they function in sexuality
  16. 16. How to use testing to measure them
  17. 17. How to coordinate treatment between therapists and medical providers
  18. 18. Suggested resource books for further in depth reading and independent study. </li></ul>
  19. 19. <ul>What this presentation is not: </ul><ul><li>Not a substitute for a comprehensive course in endocrinology and neuroscience
  20. 20. Does not cover many details or the in-depth functions of hormones & neurotransmitters </li></ul>
  21. 21. Hormone Basics: Lets get in touch with our own hormones and neurotransmitters ...right now brain
  22. 22. <ul>How do you feel right now? </ul><ul><li>Notice </li></ul><ul><ul><li>Emotion
  23. 23. Breathing
  24. 24. Heart rate
  25. 25. Relaxation/peacefulness
  26. 26. Tension/anxiety </li></ul></ul>
  27. 27. Think of stepping on a rattlesnake. What emotion do you feel?
  28. 28. Catch a snowflake on your tongue. What emotions do you feel?
  29. 29. Think of a Romantic kiss. What emotions do you feel?
  30. 30. When life gets really funny what emotions do you feel?
  31. 31. <ul>Thoughts trigger Emotions Emotions trigger Thoughts </ul>
  32. 32. Our moods are created by Hormones & Neurotransmitters
  33. 33. Lets take a closer look at how they act inside the body
  34. 34. <ul>Basics - hormones </ul><ul><li>Q. What is a hormone?
  35. 35. A chemical secreted into blood by endocrine glands or specialized glandular cells in brain, viscera, or neuroendocrine system.
  36. 36. They circulate and affect target organs & cells that have receptors for them.
  37. 37. They are regulated by other hormones, neurotransmitters or feedback loops.
  38. 38. Hormones are “dictators” they tell other substances what to do and how to behave. Some are “bullies” wrecking havoc in human moods and behavior. </li></ul>
  39. 39. <ul>Basics - Neurotransmitters </ul><ul><li>Q. What is a neurotransmitter?
  40. 40. A chemical produced and released by brain or nerve cells to induce activity in other brain or nerve cells.
  41. 41. Like hormones, they can be “dictators” and “bullies” of human moods and behavior. </li></ul>
  42. 42. <ul>Basics - glands </ul><ul><li>Q. What is a gland?
  43. 43. A. An organ that manufactures and secretes a product.
  44. 44. There are two major kinds: </li></ul><ul><ul><li>Endocrine – Makes and releases its product directly into the blood/lymph
  45. 45. Exocrine- discharges its products through ducts into intestines or outside the body </li></ul></ul>
  46. 46. <ul>Basics - glands </ul><ul><li>Major Endocrine glands </li></ul><ul><ul><li>Pituitary, hypothalamus, pineal, thyroid, parathyroid, thymus, adrenal, pancreas, ovaries, testes </li></ul></ul><ul><li>Major Exocrine glands </li></ul><ul><ul><li>Tear glands, salivary, mammary, liver, intestinal glands, sweat, bulbo-urethral or Cowper’s (male), Bartholin’s (female), sebaceous </li></ul></ul>
  47. 47. <ul>Location of Endocrine Glands </ul>
  48. 49. <ul>Endocrine glands primary to sexual function </ul><ul><li>Pituitary (acting with hypothalamus)
  49. 50. Adrenals
  50. 51. Ovaries
  51. 52. Testicles
  52. 53. Prostate </li></ul>
  53. 54. <ul>Endocrine glands commonly associated with basic sexual functions </ul>
  54. 55. <ul>Location of Pituitary Gland </ul>
  55. 58. <ul>Basic Structure & Hormones Master glands that regulate other glands and body systems </ul>
  56. 59. <ul>Hypothalamic Hormone Regulation of Pituitary Hormone Release </ul>
  57. 60. <ul>Feedback loop (example - testis) </ul>
  58. 61. <ul>Hypothalamic & Pituitary Hormonal Mechanisms </ul>
  59. 62. <ul>Basic Structure & Hormones Regulates other glands & multiple body systems </ul><ul><li>Mineralcorticoids </li></ul><ul><ul><li>Electrolyte balance </li></ul></ul><ul><li>Glucocorticoids </li></ul><ul><ul><li>Metabolism-Pro/Fat/Carb </li></ul></ul><ul><li>Androgens/Estrogens </li></ul><ul><ul><li>Gonads & Sexuality </li></ul></ul><ul><li>Norephinephrine </li></ul><ul>& Ephinephrine (Vasoconstrictors) (Active in attraction) Cardiac, arterial, gastrointestinal, & metabolic rates </ul>
  60. 63. <ul>Basic Structure & Hormones Regulates fertility, sexual characteristics & behavior </ul>
  61. 64. <ul>Basic Structure & Hormones Regulates fertility, sexual characteristics & behavior </ul>
  62. 65. <ul>Endocrine Glands secondary to sexual function </ul>
  63. 66. <ul>Basic Structure & Hormones Appears to regulate puberty and fertility </ul><ul><li>Only organ to produce melatonin
  64. 67. Converts serotonin to melatonin
  65. 68. Melatonin inhibits ovarian growth
  66. 69. 2 nd only to kidney in high blood flow </li></ul>
  67. 70. <ul>Basic Structure & Hormones Regulates metabolism and blood calcium/phosphorous </ul>
  68. 71. <ul>Basic Structure & Hormones Regulates immune system/lymphocytes and cell functioning </ul>
  69. 72. <ul>Basic Structure & Hormones Circulates hormones, regulates blood pressure and adrenal gland </ul><ul><li>Atrial natriuretic peptide (ANP) </li></ul><ul><ul><li>Enhances urinary excretion of sodium & regulates blood pressure and adrenal hormone release </li></ul></ul>
  70. 73. <ul>Basic Structure & Hormones Regulates smooth muscle vasodilation & blood </ul><ul><li>Prostaglandins </li></ul><ul><ul><li>Mediator of erection & lubrication (Smooth muscle dilation and tissue sensation) </li></ul></ul><ul><li>Erythropoietin </li></ul><ul><ul><li>Regulates blood cell production </li></ul></ul><ul><li>Renin </li></ul><ul><ul><li>Regulates blood volume & thirst </li></ul></ul>
  71. 74. <ul>Basic Structure & Hormones Regulates digestion and energy production </ul>
  72. 75. <ul>Basic Structure & Hormones Regulates metabolism, digestion & energy </ul>
  73. 76. <ul>The Hormonal Mobile </ul><ul><li>Sexual chemistry is produced in a variety of locations.
  74. 77. Body systems interact holistically.
  75. 78. As in an artists mobile, change in one hormonal element can effect changes elsewhere in body systems.
  76. 79. Sexual function can be affected indirectly by hormones other than the primary “sex” hormones. </li></ul>
  77. 80. <ul>Major Hormones & Neurochemistry that affect sexuality </ul>
  78. 81. <ul>“ Sex Soup” </ul><ul><li>“ Clearly, our mating dance, the desires that drive and frustrate us, the bonds we make, the love we give and take, the hearts we break, the differences that delight and infuriate us, the mystery of attraction, 'sexual chemistry,’ the agonies and ecstasies of intimacy - all this and more, is influenced by the ever-changing bouillabaisse of chemicals in our bodies that I think of as sex soup.” </li></ul><ul>(Crenshaw, 1996, The Alchemy of Love & Lust) </ul>
  79. 82. <ul>Meet the Love Brigade (Ingredients of “Sex Soup”) </ul><ul><li>1. DHEA – Desire
  80. 83. 2. Pheromones – Attract (sensual intimacy from scent)
  81. 84. 3. Oxytocin – Bonding (“superglue” triggered by touch)
  82. 85. 4. PEA – Euphoria (the romantic “love” molecule)
  83. 86. 5. Estrogen – Receptive (receptive sex drive)
  84. 87. 6. Testosterone – Desire (assertive sex drive)
  85. 88. 7. Serotonin – Switches sex drive on & off
  86. 89. 8. Dopamine – Pleasure (“addicts” us to each other)
  87. 90. 9. Progesterone – Repels (kills sex drive, promotes nurturing)
  88. 91. 10. Prolactin – Diminishes Sex Drive (stimulates nursing)
  89. 92. 11. Vasopressin – Regulates desire & attachment (monogamy)
  90. 93. Supporting Cast - Over 30 other chemicals that influence sexuality in some way </li></ul><ul>The Alchemy of Love and Lust , Crenshaw, T.L., (1996) </ul>
  91. 94. <ul>Sex soup du jour </ul><ul><li>Hormones fluctuate in hourly, daily, monthly & seasonal cycles
  92. 95. Instead of asking, “What sign are you?”, sexologists want to know “What hour, or day, is your hormonal cycle in?” </li></ul>
  93. 96. <ul><li>Sexual Hormone Peaks (sex soup menu) </li></ul><ul><li>Females cycle monthly
  94. 97. Testosterone High
  95. 98. Estrogen High
  96. 99. Ovulating
  97. 100. Progesterone High
  98. 101. PMS
  99. 102. Males & Females have distinct predictable sexual stages that change their nature each decade </li></ul><ul><li>Males cycle daily
  100. 103. AM Testosterone peaks
  101. 104. Hourly mini-cycles of hormones </li></ul>
  102. 105. <ul>Basic Sex Hormone & Neurochemical Profiles (Love Brigade Close-ups) </ul>
  103. 106. <ul>DHEA Profile </ul><ul><li>DHEA (Dehydroepiandrosterone)-steroid hormone
  104. 107. Significant affect: Desire
  105. 108. Nickname: Mother of all hormones
  106. 109. Produced- Adrenal Glands </li></ul><ul><ul><li>(secondary production – ovaries, testicles & brain) </li></ul></ul><ul><li>Function </li></ul><ul><ul><li>The most abundant hormone in the human body
  107. 110. Most sex hormones are derived from DHEA
  108. 111. Involved in sex drive, orgasm, and sex appeal </li><ul><li>Increases drive more in women than men
  109. 112. Pheromone precursor </li></ul><li>Exercise increases DHEA - Birth control pills decrease
  110. 113. Peaks at age 25 then declines </li></ul></ul>
  111. 114. <ul>Pheromone Profile </ul><ul><li>Odorous skin secretion derived from DHEA
  112. 115. Significant affect: Attraction
  113. 116. Nickname: Perfume (come hither)
  114. 117. Produced – Various sites / skin
  115. 118. Function </li></ul><ul><ul><li>-Attractant transmitted through scent
  116. 119. -Creates a sense of well-being and intimacy
  117. 120. -Produces more sensual feeling than raw lust
  118. 121. -May act on brain & nervous system through the
  119. 122. vomero nasal organ (VMO)
  120. 123. -Animals use to mark territory/repel competition as well as to attract </li></ul></ul>
  121. 124. <ul>Oxytocin Profile </ul><ul><li>Hormone
  122. 125. Significant affect: Bonding
  123. 126. Nickname: Hormonal superglue
  124. 127. Produced – Hypothalamus
  125. 128. Function </li></ul><ul><ul><li>Human bonding (mating, parenting, sex)
  126. 129. Spikes during orgasm
  127. 130. Produced in response to, or anticipation of, touch
  128. 131. Stimulates uterine contractions in delivery
  129. 132. May stimulate contractions of ejaculatory tract
  130. 133. Causes contraction of alveoli in mammary glands forcing milk into the nipples </li></ul></ul>
  131. 134. <ul>PEA Profile phenylethelamine </ul><ul><li>Significant Affect: Euphoria
  132. 135. Nickname: The love molecule
  133. 136. Produced – In brain neurons
  134. 137. Function </li></ul><ul><ul><li>“ In love” euphoria (amphetamine like substance)
  135. 138. Stimulant, spikes at orgasm, ovulation
  136. 139. Causes giddiness and excitement
  137. 140. Found in chocolate and nutrasweet
  138. 141. Acts like a diet pill – appetite supressant
  139. 142. Stimulated by anticipation, erotica or fantasy
  140. 143. May be significant in “love at first sight” </li></ul></ul>
  141. 144. <ul>Estrogen Profile </ul><ul><li>Hormones (estradiol, estrone, estriol)
  142. 145. Significant affect: Receptivity
  143. 146. Nickname: Marilyn Monroe
  144. 147. Produced - adrenal glands, ovaries, testes, adipose tissue (fat), and the brain
  145. 148. Function- </li></ul><ul><ul><li>Sexual differentiation & development
  146. 149. Receptive sex drive and sexual frequency
  147. 150. Vaginal lubrication, body scent & texture
  148. 151. Stabilizes mood and improves cognition & reactions
  149. 152. Prevents heart disease, osteoporosis, schizophrenia
  150. 153. Mild antidepressant
  151. 154. Improves sense of taste and smell </li></ul></ul>
  152. 155. <ul>Testosterone Profile </ul><ul><li>Hormone (steroid)
  153. 156. Significant affect: Assertive
  154. 157. Nickname: Nature’s Aphrodisiac
  155. 158. Produced - adrenal glands, ovaries, testes, & some perephial tissues
  156. 159. Function- </li></ul><ul><ul><li>Sexual differentiation & development
  157. 160. Assertive & compelling sexual desire in all sexes
  158. 161. Antidepressant in all sexes
  159. 162. Is pulsatile (15 min), fluctuates daily and seasonally
  160. 163. Increases erotic thought and fantasy
  161. 164. Males average 10 times the T level of women </li></ul></ul>
  162. 165. <ul>Serotonin Profile </ul><ul><li>Neurotransmitter (5-HT)
  163. 166. Significant Affect: Inhibitory (Modulator)
  164. 167. Nickname: Dr. Jekell
  165. 168. Produced – In brain neurons
  166. 169. Function </li></ul><ul><ul><li>Regulates sexual aggressiveness & partner discrimination (high cool/low hot)
  167. 170. High S = (hyposexual) Peaceful, sexually selective, inhibits drive & orgasm
  168. 171. Low S = (hypersexual) Aggressive, sexually indiscriminate, anxious, impulsive, rapid ejaculation
  169. 172. More abundant and influential in females </li></ul></ul>
  170. 173. <ul>Serotonin / Testosterone Seesaw </ul><ul>Testosterone </ul><ul>Serotonin </ul><ul>Serotonin </ul><ul>Testosterone </ul><ul>Female Natural State Male Natural State </ul><ul>There is good evidence that when one substance is up the other is down </ul>
  171. 174. <ul>Dopamine Profile </ul><ul><li>Neurotransmitter
  172. 175. Significant Affect: Pleasure
  173. 176. Nickname: Pleasure Junkie
  174. 177. Produced – Hypothalamus
  175. 178. Function </li></ul><ul><ul><li>Gives pleasure & motivates action
  176. 179. Intrinsic to sexual attraction, desire, arousal, response, orgasm and satisfaction
  177. 180. May be what “addicts” us to each other
  178. 181. Neurochemical of physical addiction/substance abuse
  179. 182. Increases sex drive & facilitates orgasm
  180. 183. Reciprocal to oxytocin </li></ul></ul>
  181. 184. <ul>Progesterone Profile </ul><ul><li>Hormone
  182. 185. Significant Affect: Inhibitory
  183. 186. Nickname: Antiaphrodisiac
  184. 187. Produced – Ovary (in the corpus luteum)
  185. 188. Function </li></ul><ul><ul><li>Promotes nurturing and protective behavior and supports breast feeding
  186. 189. Inhibits sex drive
  187. 190. Decreases testosterone, genital sensation, touch perception, pheromone transmission and perception, uterine contractibility, sensitivity to oxytocin
  188. 191. Reduces dopamine & pleasure
  189. 192. Can cause depression and irritability
  190. 193. Increases fluid retention & weight gain </li></ul></ul>
  191. 194. <ul>Prolactin Profile </ul><ul><li>Hormone
  192. 195. Significant Affect: Inhibitory
  193. 196. Nickname: Moo Juice
  194. 197. Produced – Pituitary
  195. 198. Function </li></ul><ul><ul><li>Lactation
  196. 199. Cause of low sex drive in nursing mothers
  197. 200. Sexually inhibiting (in men & women)
  198. 201. Involved in sperm production & genital maintenance
  199. 202. Surges during stress
  200. 203. High levels decrease testosterone </li></ul></ul>
  201. 204. <ul>Vasopressin Profile </ul><ul><li>Hormone
  202. 205. Significant Affect: Modulates desire
  203. 206. Nickname: Monogamy molecule
  204. 207. Produced – Pituitary
  205. 208. Function </li></ul><ul><ul><li>Modulates testosterone
  206. 209. Has a “tempering” influence on social sexual behavior and pheromonal communication
  207. 210. Improves memory and cognition
  208. 211. Activates attention and focus on sexual stimuli </li></ul></ul>
  209. 212. <ul>Sexually Excitatory Endogenous Substances </ul><ul><li>Adrenergic Alpha1
  210. 213. Adrenergic Beta2
  211. 214. CGRP
  212. 215. Cholinergic Activity
  213. 216. DHEA/DHEAS
  214. 217. Dopamine
  215. 218. EDRF
  216. 219. Estrogen (F only)
  217. 220. Excitatory Peptides
  218. 221. Growth Hormone </li></ul><ul><li>Histamine
  219. 222. LHRH
  220. 223. Nitric Oxide
  221. 224. Oxytocin
  222. 225. Prostaglandins
  223. 226. Substance P
  224. 227. Testosterone
  225. 228. VIP
  226. 229. Vasopressin
  227. 230. Zinc </li></ul><ul>Sexual Pharmacology – Crenshaw & Goldberg (1996) p.39 </ul>
  228. 231. <ul>Sexually Inhibiting Endogenous Substances </ul><ul><li>Adrenergic Alpha2
  229. 232. Angiotensen II
  230. 233. Cortisol
  231. 234. Estrogen (M only)
  232. 235. Melatonin
  233. 236. Monoamine Oxidase
  234. 237. Neuropeptide Y </li></ul><ul><li>Opioids
  235. 238. Progesterone
  236. 239. Prolactin
  237. 240. Serotonin (5HT)
  238. 241. Thyroid Hormone
  239. 242. Vasoconstrictive Peptides </li></ul><ul>Ang II and NPY </ul><ul>Sexual Pharmacology – Crenshaw & Goldberg (1996) p.40 </ul>
  240. 243. <ul>Basic Ovarian Function </ul>
  241. 244. <ul>The Ovary </ul>
  242. 245. <ul>Pituitary/Ovary/Endometrium Cycle </ul>
  243. 246. <ul>Production Rate of Sex Steroids in Women at Different Stages of the Menstrual Cycle </ul><ul>  </ul><ul>DAILY PRODUCTION RATE </ul><ul>SEX STEROIDS* </ul><ul>Early Follicular  </ul><ul>Preovulatory  </ul><ul>Midluteal </ul><ul>Progesterone (mg) </ul><ul>1 </ul><ul>4 </ul><ul>25 </ul><ul>17-Hydroxyprogesterone (mg) </ul><ul>0.5  </ul><ul>4  </ul><ul>4  </ul><ul>Dehydroepiandrosterone (mg) </ul><ul>7 </ul><ul>7  </ul><ul>7  </ul><ul>Androstenedione (mg) </ul><ul>2.6 </ul><ul>4.7 </ul><ul>3.4 </ul><ul>Testosterone (  g) </ul><ul>144  </ul><ul>171  </ul><ul>126  </ul><ul>Estrone (  g) </ul><ul>50  </ul><ul>350  </ul><ul>250  </ul><ul>Estradiol (  g) </ul><ul>36 </ul><ul>380 </ul><ul>250 </ul><ul>From Baird DT. Fraser IS. Blood production and ovarian secretion rates of esuadiol-17  and estrone in women throughout the menstrual cycle. J Clin Endocri-nol Metab 38: l009-1017. 1974. @ The Endocrine Society. </ul><ul>*Values are expressed in milligrams or micrograms per 24 hours. </ul><ul>Table 1. Production Rate of Sex Steroids in Women at Different Stages of the Menstrual Cycle </ul><ul>  </ul><ul>DAILY PRODUCTION RATE </ul><ul>SEX STEROIDS* </ul><ul>Early Follicular  </ul><ul>Preovulatory  </ul><ul>1 </ul><ul>25 </ul><ul>Androstenedione (mg) </ul><ul>2.6 </ul><ul>4.7 </ul><ul>3.4 </ul><ul>Testosterone (  g) </ul><ul>144  </ul><ul>171  </ul><ul>126  </ul><ul>Estrone (  g) </ul><ul>50  </ul><ul>350  </ul><ul>250  </ul><ul>Estradiol (  g) </ul><ul>36 </ul><ul>380 </ul><ul>250 </ul><ul>From Baird DT. Fraser IS. Blood production and ovarian secretion rates of esuadiol-17  and estrone in women throughout the menstrual cycle. J Clin Endocri-nol Metab 38: l009-1017. 1974. @ The Endocrine Society. </ul><ul>*Values are expressed in milligrams or micrograms per 24 hours. </ul>
  244. 247. <ul>Female Cyclic Hormonal Behavioral Patterns </ul><ul><li>The “four seasons” of love </li></ul><ul><ul><li>Seductive (proceptive) high gear </li><ul><li>Testosterone </li></ul><li>Assertive (active) low gear </li><ul><li>Estrogen & Oxytocin </li></ul><li>Receptive (passive) neutral </li><ul><li>Estrogen </li></ul><li>Aversive (negative) reverse </li><ul><li>Progesterone, prolactin, vasopressin & serotonin </li></ul></ul></ul><ul><ul><li>The Alchemy of Love and Lust (Crenshaw, T.L., 1997 pp 169-174). </li></ul></ul>
  245. 248. Biochemical Behavioral Interactions for 'Love' <ul><li>3 Behavioral Biochemical/Brain Systems </li></ul><ul><ul><li>Sex Drive System (Libido/Lust) </li><ul><li>androgens & estrogens (inhibitory-progesterone) </li></ul><li>Attraction System </li><ul><li>dopamine, norepinephrine & decreased serotonin </li></ul><li>Attachment System </li><ul><li>oxytocin & vasopressin </li></ul></ul></ul><ul>Fisher, H.E., Aron, A., Mashek, M.A. et al. (2002). Defining the brain systems of lust, romantic attraction & attachment. Archives of Sexual Behavior, 31(5), 413-419. </ul>
  246. 249. How can AASECT Educators, Counselors and Therapists apply this knowledge in the real world?
  247. 250. <ul>Clinical, Educational & Research Applications of Hormone Measures </ul><ul><li>Sexual functioning </li></ul><ul><ul><li>Adjust hormone levels </li></ul></ul><ul><li>Gender identity </li></ul><ul><ul><li>Masculinize or feminize </li></ul></ul><ul><li>Fertility & Birth Control </li></ul><ul><ul><li>Regulate conception </li></ul></ul><ul><li>Sex offenders </li></ul><ul><ul><li>Adjust hormone levels </li></ul></ul><ul><li>Research </li></ul><ul><ul><li>Measure hormonal effects </li></ul></ul>
  248. 251. Development of the biopsychosocial model and multidisciplinary sexuality health care
  249. 252. <ul>Iwan Bloch M.D 1872-1922 </ul><ul><li>Bloch, an early founder of sexual science, coined the term “sexualwissenschaft” (sexology).
  250. 253. The sexologist views sexual life from a “centralized standpoint” among the comprehensive whole of available knowledge. </li></ul><ul>Bloch, I. (1907) The Sexual Life of Our Time </ul>
  251. 254. <ul><li>Viewing sexual life from a “centralized standpoint” makes sexology multi-disciplinary in nature
  252. 255. It is difficult to be an expert in the many disciplines that encompass sexology
  253. 256. Basic understanding of endocrinology and its influence on sexuality is an essential part of being a sexologist, sex educator, counselor or therapist </li></ul><ul>Sexology </ul><ul>Arts </ul><ul>Sciences </ul><ul>Law </ul><ul>Theology </ul><ul>etc </ul>
  254. 257. <ul>Biopsychosocial Model of Sexuality Heathcare </ul>Developed by Engel & Romano 1970-80's Recognizes a need for a multidisciplinary approach to diagnosis & treatment. Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-136. Engel GL: The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-544.
  255. 258. Biopsychosocial Model
  256. 259. <ul>Biopsychosocial Sexual Influences </ul>
  257. 260. <ul>Biopsychosocial Assessment </ul><ul><li>Sample Assessment - 22 year old married female
  258. 261. Diagnosis - Hypoactive Sexual Desire & Vaginismus </li></ul>
  259. 262. Comprehensive Care <ul>Tremendous benefit can be derived from medications that treat and cure sexual problems. They are valuable supplements to therapy, it is critical that they not be used as substitutes for therapy. Chemicals should not be used to depersonalize sex, or transform it into a mechanically successful event that disregards the emotional context of the individual or relationship. <ul><ul><ul><ul><ul><ul><ul><li>Crenshaw & Goldberg (1996) Sexual Pharmacology </li></ul></ul></ul></ul></ul></ul></ul></ul>
  260. 263. Need for teamwork <ul>“ ...nonphysicians need to be informed about the type of medications that can interfere with psychotherapy and sex therapy...both patients and physicians often have difficulty in discussing sexual issues...many physicians are unaware of their own ignorance in this area.” <ul><ul><ul><ul><ul><ul><ul><li>Crenshaw & Goldberg (1996) Sexual Pharmacology </li></ul></ul></ul></ul></ul></ul></ul></ul>
  261. 264. <ul>How Hormones are Measured with Lab Tests </ul><ul><li>Physician ordered tests
  262. 265. Patient ordered tests
  263. 266. Using mail in saliva & blood samples
  264. 267. Benefits </li></ul><ul><ul><li>Easy to use “home use” kits
  265. 268. Patient/Client takes/submits sample
  266. 269. Encloses payment and mails to lab
  267. 270. Lab reports to health care provider and patient </li></ul></ul>
  268. 271. Lab Test Examples Case A <ul><li>Married Female age 24 (premenopausal)
  269. 272. Hypoactive Sexual Desire
  270. 273. High Stress (2 yr old & Student)
  271. 274. Anxiety
  272. 275. Psychosexual shame (faith based)
  273. 276. Relationship conflict (communication) </li></ul>
  274. 277. Case A
  275. 278. Lab Test Examples Case B <ul><li>Single sexually active female age 80 (postmenopausal)
  276. 279. Using estrogen replacement
  277. 280. Noticing diminished libido
  278. 281. Usually highly interested in sex
  279. 282. Very sex positive
  280. 283. Reports </li><ul><li>Bone loss and hearing loss
  281. 284. Aches, pains, & weight gain </li></ul></ul>
  282. 285. Case B
  283. 286. Lab test examples Case C <ul><li>Married female age 56 (postmeopausal)
  284. 287. Bio-identical hormone replacement
  285. 288. Hypoactive sexual desire
  286. 289. Stress
  287. 290. Anxiety
  288. 291. Decreased stamina </li></ul>
  289. 292. Case C
  290. 293. <ul>Gender identity & hormones </ul><ul><li>Transsexual, Transvestite, Transgenderist, Androgyne, Intersex, etc. individuals may be interested in hormone therapy.
  291. 294. Many gender specialists follow guidelines for standards of care or guidelines. </li></ul><ul><ul><li>HBIGDA - Harry Benjamin International Gender Dysphoria Association
  292. 295. IFGE – International Foundation for Gender Education
  293. 296. AEGIS – American Educational Gender Education Service </li></ul></ul>
  294. 297. <ul>Common Hormone use with gender identity </ul><ul><li>MTF </li></ul><ul><ul><li>Estrogen
  295. 298. Progesterone
  296. 299. Anti-androgen drugs </li><ul><li>Spironolactone, Flutamide, Cyproterone Acetate </li></ul><li>Orchidectomy </li></ul></ul><ul><li>FTM </li></ul><ul><ul><li>Testosterone
  297. 300. Oophorectomy/Hysterectomy </li></ul></ul><ul>Transgender Care , Israel & Tarver, 1997 </ul>
  298. 301. Conclusion <ul><li>Sexual science today recognizes the need for comprehensive biopsychosocial management of sexual concerns.
  299. 302. Psychosocial sexuality care providers can better serve their patients/clients by understanding sexual biochemistry (hormones, neurotransmitters & drug affects)
  300. 303. Medical & non-medical providers need to coordinate sexual health care treatment </li></ul>
  301. 304. Sexuality Specialists often need to coordinate professional care <ul><li>Bio - Medical </li></ul><ul><li>Psychosocial - Therapy </li></ul>
  302. 305. <ul>Main References </ul><ul><li>How the Endocrine System Works , Neal, J.M., (2001).
  303. 306. Sexual Pharmacology , Crenshaw, T.L. & Goldberg, J.P. (1996).
  304. 307. Standard Practice in Sexual Medicine, Porst, H. & Buvat, J. (eds), (2006).
  305. 308. The Alchemy of Love & Lust , Crenshaw, T.L. (1996).
  306. 309. The CIBA Collection of Medical Illustrations 6 Vols . Netter, F.H. (1997).
  307. 310. The Endocrine System , Anatomical Chart Co. (2000).
  308. 311. The Science of Orgasm, Komisuruk, B.R. et al
  309. 312. (2006).
  310. 313. Why We Love, Fisher, H. (2005).
  311. 314. www.endotext.org </li></ul>

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