#1
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ãèïåðàíäðîãåíèÿ
Îáðàòèëàñü ïàöèåíòêà ñ æàëîáîé íà ïîâûøåíèå ëèáèäî, êîòîðîå åå ïóãàåò. Îíà 47 ëåò, â ïðîøëîì áàëåðèíà. Êàþñü, àíàëèçîâ ñåé÷àñ ïðåäñòàâèòü íå ìîãó. Ãèïåðàíäðîãåíèÿ ïîäòâåðæäåíà, îíà êðàéíå íåçíà÷èòåëüíà, íî âûÿâëåíà. ÔÑà -12 ìÅÄ/ë. Íà ÓÇÈ ÿè÷íèêîâ ôîëëèêóëû îïðåäåëÿþòñÿ â íåáîëüøîì êîëè÷åñòâå . Òðîïè÷åñêàÿ äèàãíîñòèêà - ÊÒ - ïîëíîñòüþ èñêëþ÷èëà îáðàçîâàíèÿ â ìàëîì òàçó è íàäïî÷å÷íèêàõ. Ïðèçíàêîâ ñèñòåìíîé ãèïåðàíäðîãåíèè íåò íèêàêèõ.
Ïðàâèëüíî ëè ìîå ïðåäïîëîæåíèå, ÷òî ýòè èçìåíåíèÿ âòîðè÷íû â ïåðèîä ïåðèìåíîïàóçû? Òàêèå ïåðåìåíû ñåêñóàëüíîãî ïîâåäåíèÿ åé êðàéíå òÿæåëû, ïóãàþò è íåïðèÿòíû â òîì ÷èñëå ìóæó. Êàê îáëåã÷èòü? Õî÷ó äàòü ïðåïàðàòû ñ öèïðîòåðîíà àöåòàòîì. íî Êëèìåí îòñóòñòâóåò â ÐÔ, îñòàþòñÿ ÊÎÊ. Âòîðîé âàðèàíò - àíòèäåïðåññàíòû. Íî îíà óæå ïðèíèìàåò Êàëèêñòó - áåç ýôôåêòà |
#2
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ß äóìàþ, ÷òî âû ïðàâû: ñêîðåå âñåãî, ïåðèìåíîïàóçàëüíûé äèñáàëàíñ ýñòðîãåíîâ è àíäðîãåíîâ.
Ðàäè èíòåðåñà, êàêîâû áûëè òåñòîñòåðîí è ÄÃÝÀÑ? Ãëàâíîå,- íå ïðîçåâàòü ãèïåðòåêîç.
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Dr.B |
#3
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Cèýòòëñêèé îïûò:
estrone glucuronide (E1G), testosterone (T), and follicle-stimulating hormone (FSH) Those with higher urinary E1G and T reported significantly higher levels of sexual desire, whereas those with higher FSH levels reported significantly lower sexual desire (p < 0.0001, 0.06, and 0.0002, respectively). Women using hormone therapy also reported higher sexual desire (p = 0.02). [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#4
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 ïÿòíèöó áóäó òàì è âûëîæó ðåçóëüòàòû! À âîò êàê ïîìî÷ü?
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#5
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íàñëîëüêî âèæó, íåò íèêàêèõ ðåêîìåíäàöèé ïî ïîâîäó ïðèìåíåíèÿ àíòèäåïpåññàíòîâ äëÿ ñíèæåíèÿ ëèáèäî â äàííîé ñèòóàöèè, âñå ïóáëèêàöèè ïðî "ïîâûcèòü óòðà÷åííîå" íà ÀÄ, ìîæåò òàêàÿ òàáëèöà áóäåò ïîëåçíîé [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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íåêîòîðûå ÀÄ ìîãóò óñèëèòü ãèïåðñåêñóàëüíîñòü, ìèðòàçàïèí áûë òîæå çàìå÷åí â åòîì [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Åñëè îæèäàòü ñóïðåññèþ ëèáèäî èëè èíîãî, ñ íèì ñâÿçàííîãî, òî ìèðòàçàïèí ñàìûõ õóäøèé èç ýòèõ 5-òè fluoxetine, paroxetine, citalopram, venlafaxine, or mirtazapine ïëþñ ó íåãî è âîò òàêîé ýôôåêò îæèäàåòñÿ: Mirtazapine is also a potent antagonist of postsynaptic 5-HT3 receptors, which may further promote orgasm. The present study, showing mirtazapine was associated with both lowest overall sexual dysfunction frequency and greatest ease of orgasm, is in line with mirtazapine's unique mechanisms of action. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
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Ïîñêîëüêó îíà ïðèøëà êî ìíå, òî ìíå-òî õî÷åòñÿ ñíèçèòü òåñòîñòåðîí êàê ïðè÷èíó
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#8
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òàê åñëè àíòè-àíäðîãåííàÿ ÇÃÒ îòñóòñòâóåò â ÐÔ òî êàê ïëàíèðóåòñÿ ñíèæàòü òåñòîñòåðîí?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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×òî òàêîå àíòèàíäðîãåííàÿ ÇÃÒ? Ðàñøèôðóéòå ñåé òåçèñ
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Ã.À. Ìåëüíè÷åíêî |
#10
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47 ëåò , ÔÑÃ íåìåíîïàóçàëüíûé. ß çà ÊÎÊ ñ öèïðîòåðîíà àöåòàòîì .
Äëÿ ýòîé ïàöèåíòêè ïðîáëåìà êðàéíå çíà÷èìà |
#11
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íàâåðíîå, íå ñîâñåì òî÷íûé ïåðåâîä, èìåë â âèäó ýòî:
"HRT with antiandrogenic progestogens" Climacteric. 2000 Dec:3 Suppl 2:21-7. The role of antiandrogens in hormone replacement therapy [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#12
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Öèòàòà:
âîò ÷òî ïîïàëîñü - æåíùèíàì ñ ÑÏÊß äàâàëè 35 μg ethinyl estradiol and 2 mg cyproterone acetate òðè ìåñÿöà - èõ îáùèé òåñòîñòåðîí ñíèçèëñÿ ñ ng/mL 0.40+/-0.1 äî 0.33+/-0.1 = −0.06 (ñíèæåíèå íà 15%)
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#13
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Ñïàñèáî. ß íàçíà÷àëà öèïðîòåðîíà àöåòàò - Àíäðîêóð òðàíññåêñóàëàì ñ îòëè÷íîé äèíàìèêîé. Çäåñü äàì íà êîðîòêîå âðåìÿ è îòïèøóñü îá ýôôåêòå
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#14
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äîáàâëþ, ÷òî â àíäðîêóðå äîçà ëåêàðñòâà â ðàçû áîëüøå â 12 ðàç, åñëè ñðàâíèâàòü ñ 25 ìã, ïîåòîìó îíà ìîæåò áûòü è íå ñðàâíèìà ñ òîé ÷òî â ÊÎÊ, íà âàøå óñìîòðåíèå, íî íàâåðíîå íóæíî ïîäñêàçàòü ïàöèåíòêå, åñëè îíà õî÷åò ïðèåì è àíòèäåïðåññàíòà, òî åé ñ î÷íûì ïñè-ñïåöèàëèñòîì íóæíî ïåðåéòè íà òîò, ÷òî îáëàäàåò áîëüøèì/áîëåå ÷àñòûì ëèáîäî-ñóïðåññèâíûì åôôåêòîì, ñ êàëèêñòû/ìèðòàçàïèíà
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#15
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Äîáàâëÿþ
Òåñòîñòåðîí îáùèé = 0.683 è 0.690 (ðåôåðåíñ 0.084 - 0.481)íã/ìë, ÄÃÀ-S = 12.3 (0.96-6.95) ììîëü/ë, ýñòðàäèîë 102.ïã/ìë (48-211) |