As Valentine’s Day approaches, patients are likely to seek treatment for addressing sexual health concerns such as low libido, erectile dysfunction, and menopausal symptoms. These issues may be related to underlying health issues or medication usage, but they can also be caused by a lack of confidence due to a negative self-image. They can affect men and women of any age, but they tend to become worse with age. Fortunately, there are a variety of compounded preparations available to help improve the sexual health of men and women of any age.
Compounding to Improve Sexual Dysfunction Caused by Medications
Numerous medications, including antidepressants and antihypertensives (1), have been linked with sexual dysfunction in both men and women, especially as the number of individual medications increases, i.e., polypharmacy (2). Researchers at Mayo Clinic showed that antidepressant usage is associated with problems achieving orgasm in as many as 42 percent of women, of which 72 percent had problems with sexual desire and 83 percent had issues with sexual arousal (3). In men, erectile function can potentially be improved by tailoring or tapering their current medication use to maximize therapeutic effectiveness while minimizing erectile dysfunction (2). Antihypertensive drugs, especially β-blockers, have shown to impair sexual function in both men and women in a dose-dependent manner (4).
Although sexual dysfunction as a result of medication is generally a secondary concern, it is important to address it because it may decrease treatment adherence and ultimately jeopardize the success of long-term therapy (1). Pharmacological approaches can address medication-induced sexual dysfunction, such as switching medication types or dose-tapering to maintain effectiveness while decreasing sexual adverse events. For patients requiring precise dose tapering or dose modulation that cannot be obtained using commercially-available medications, a compounding pharmacy can provide compounded preparations with patient-specific doses (5).
Confidence is Sexy: Compounded Medications to Address Appearance Concerns
Although sexual health may be compromised by health-related conditions or medications a patient is taking, a patient’s confidence can also affect their sexual performance (6). As they age, patients may begin to express concerns about their appearance, especially their skin and hair loss. For patients who want a confidence boost in the bedroom or elsewhere, chemical peels can help freshen up their skin appearance.
Some medications can help prevent hair loss and even regrow hair, but these may also cause negative sexual side effects. Androgenetic alopecia affects both men and women, but the use of hair loss medications may cause sexual dysfunction in a small percentage of men. Numerous studies, including one from Northwestern Medicine, have shown that the use of 5α-reductase inhibitors – such as finasteride and dutasteride for hair loss – may cause adverse sexual side effects in a small percentage of males, including erectile dysfunction and lower libido (7).
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If patients are experiencing sexual dysfunction due to the administration of oral finasteride or minoxidil, these two drugs can be compounded in a topical form to potentially reduce their sexual side effects by reducing their systemic circulation (8,9).
Bioidentical Hormone Replacement Therapy (BHRT)
In addition to appearance and medications, underlying health issues and hormonal imbalances are also causal factors for sexual dysfunction in both men and women. Blood tests are performed to test levels of hormones associated with the inability to sustain an erection, vaginal dryness, or a lack of sexual appetite. These imbalances can be addressed with bioidentical hormone replacement therapy (BHRT) using plant-derived testosterone, estrogen, and progesterone that are chemically identical to their endogenous forms.
Compounded Preparations for Men’s Health
Imbalances in hormones such as testosterone can lead to sexual side effects in males, including erectile dysfunction, low libido, loss of lean muscle mass, and lethargy. As one of our BHRT offerings, testosterone replacement therapy is available as topical creams, gels, and intramuscular (IM) injection. In our topical creams, we use a hydrogel base that ensures a high absorption percentage of testosterone, leading to superior results compared with other bases. Medications compounded with this base cross the skin layer quickly without leaving behind a repellant and sticky residue. This hydrogel base is formulated without alcohol to deliver a significantly more tolerable experience on the skin, helping prevent skin reactions, especially in patients with sensitive skin.
In addition to testosterone, diseases affecting thyroid hormones may also cause men to experience sexual dysfunction. We can work closely with prescribers and advise on educating these patients about hyperthyroidism/hypothyroidism, as well as what a proper replacement protocol and hormone administration would look like to improve their sexual health. We offer:
- Bioidentical thyroid replacement therapy (T3 and/or T4)
- Essential thyroid hormones that work in tandem to control your body’s metabolism.
- Commercially available thyroid hormones including slow release, Nature-Thyroid and Armour Thyroid.
- Dehydroepiandrosterone (DHEA), which has also been suggested in some studies to improve sexual function.
Males taking BHRT involving testosterone may experience additional hair loss due to the conversion of testosterone to DHT. Therefore, 5-alpha reductase inhibitors (the enzyme responsible for the conversion of testosterone to DHT), such as finasteride and dutasteride, may be appropriate to administer without affecting the success of either therapy (10).
Compounded Preparations for Women’s Health
Women may experience sexual dysfunction or dissatisfaction, including desire, arousal, and orgasm disorders. As noted above, these symptoms can be associated with medications such as cardiovascular and antihypertensive medications and psychotropics. VLS & New Drug Loft offers a variety of compounded medications for women’s health, including sexual and reproductive health.
Vaginal dryness occurs in women of any age, especially in post-menopausal women or after gynecological surgery. Females may take BHRT with estrogen or progesterone to improve vaginal lubrication to improve pain during sex. Some compounded options for addressing vaginal dryness include:
- Vitamin E 200 IU vaginal suppository
- Estriol 0.05% vaginal cream
Atrophic Vaginitis also occurs more frequently in post-menopausal women. Compounded preparations for treating it include:
- Estriol 1 mg/Progesterone 30 mg vaginal suppository
- Hyaluronic acid 5 mg/Gm vaginal cream
- Dehydroepiandrosterone 13 mg vaginal suppository
- Estriol 5 mg/mL vaginal cream
- Acidophilus Lactobacillus vaginal cream
Our Deep-Permeating Liposomal Base
Another of our bases is our liposomal base, which is ideal for deep-penetrating topical formulations and allows for both local and systemic absorption of APIs. This base can also deliver up to four different APIs at once, which is particularly important when combination therapy is necessary to address sexual health issues. The benefits of our liposomal base include:
- Enhanced delivery: The simultaneous delivery of a combination of active ingredients in a compounded medication is often difficult, but our deep-permeating liposomal base supports transdermal absorption of up to four active compounds in a single preparation. There are also no concerns regarding the stability, preservation of individual properties of the drug, or drug-drug physical interactions.
- Quality, efficiency, and convenience: This base offers improved quality and efficiency for compounding pharmacists and increased convenience for patients.
- Physical stability: Our deep-permeating base is potent and efficient for various storage conditions, making it flexible for use in cold creams that require refrigeration.
- Soothes sensitive skin: This deep-permeating base makes compounded creams suitable for use on sensitive skin in intimate areas. Due to the finesse of its texture, it can be used to compound smooth, silky creams and gels that are sufficiently stable for testosterone products as well as bioidentical hormone replacement therapy.
Oxytocin to Enhance Sexual Satisfaction
Oxytocin is a hormone synthesized in the hypothalamus and released by the pituitary gland. It plays a role in modulating sexual behavior and response. It may enhance sexual satisfaction in both men and women, and studies have suggested that oxytocin may contribute to increased arousal, orgasm intensity, and emotional connectedness during sex by promoting relaxation and reducing anxiety (11).
In postmenopausal women, oxytocin vaginal gel improves vaginal atrophy and sexual function (12). As shown below, the administration route of oxytocin can change depending on whether a patient requires a more systemic or localized effect, as determined by a patient’s specific needs.
- Oxytocin 40 units/mL nasal spray
- Oxytocin 40 units/Gm vaginal cream
VLS Pharmacy and New Drug Loft
As a 503A pharmacy specializing in sterile and non-sterile compounding, we will support you and your patients by creating safe, individualized, and effective pharmaceutical therapies for addressing their sexual health concerns. For men and women at any age, feeling healthy, conﬁdent, and comfortable is of the utmost importance. Your patients’ needs, especially those related to their appearance and sexual health, will change with each life stage. As such, they require an adaptive and personalized treatment plan. By working with a trusted compounding pharmacy like VLS Pharmacy and New Drug Loft, you are expanding the possibilities for successful and sustainable care.
Please comment below with any thoughts or questions. Reach out to our team to learn about building trust and long-lasting patient relationships. All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.
- Lou IX, Chen J, Ali K, Chen Q. Relationship Between Hypertension, Antihypertensive Drugs and Sexual Dysfunction in Men and Women: A Literature Review. VHRM. 2023;19:691-705. doi:10.2147/VHRM.S439334
- Londoño DC, Slezak JM, Quinn VP, Van Den Eeden SK, Loo RK, Jacobsen SJ. Population-based study of erectile dysfunction and polypharmacy. BJU Int. 2012;110(2):254-259. doi:10.1111/j.1464-410X.2011.10761.x
- Lorenz T, Rullo J, Faubion S. Antidepressant-Induced Female Sexual Dysfunction. Mayo Clin Proc. 2016;91(9):1280-1286. doi:10.1016/j.mayocp.2016.04.033
- Doumas M, Douma S. The Effect of Antihypertensive Drugs on Erectile Function: A Proposed Management Algorithm. J Clin Hypertens (Greenwich). 2007;8(5):359-363. doi:10.1111/j.1524-6175.2005.05285.x
- Montejo AL, Prieto N, de Alarcón R, Casado-Espada N, de la Iglesia J, Montejo L. Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach. J Clin Med. 2019;8(10):1640. doi:10.3390/jcm8101640
- San Martín C, Simonelli C, Sønksen J, Schnetzler G, Patel S. Perceptions and opinions of men and women on a man’s sexual confidence and its relationship to ED: results of the European Sexual Confidence Survey. Int J Impot Res. 2012;24(6):234-241. doi:10.1038/ijir.2012.23
- Mysore V. Finasteride and sexual side effects. Indian Dermatol Online J. 2012;3(1):62-65. doi:10.4103/2229-5178.93496
- Piraccini BM, Blume-Peytavi U, Scarci F, et al. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol. 2022;36(2):286-294. doi:10.1111/jdv.17738
- Gupta AK, Talukder M. Topical finasteride for male and female pattern hair loss: Is it a safe and effective alternative? J Cosmet Dermatol. 2022;21(5):1841-1848. doi:10.1111/jocd.14895
- Musculoskeletal and prostate effects of combined testosterone and finasteride administration in older hypogonadal men: a randomized, controlled trial – PMC. Accessed January 26, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4073894/
- Cera N, Vargas-Cáceres S, Oliveira C, et al. How Relevant is the Systemic Oxytocin Concentration for Human Sexual Behavior? A Systematic Review. Sexual Medicine. 2021;9(4):100370. doi:10.1016/j.esxm.2021.100370
- Abedi P, Zohrabi I, Ansari S, Maraghi E, Maram NS, Houshmand G. The Impact of Oxytocin Vaginal Gel on Sexual Function in Postmenopausal Women: A Randomized Controlled Trial. J Sex Marital Ther. 2020;46(4):377-384. doi:10.1080/0092623X.2020.1738606
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