Circulating Androgen Levels and Self-reported Sexual Function in Women

Davis, Susan R.; Davison, Sonia Louise; Donath, Susan; Bell, Robin Jean

doi:10.1001/jama.294.1.91

Cited by 468 publications

(189 citation statements)

References 30 publications

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“…Importantly, a recently published cross-sectional study in a large cohort of Australian women (n ¼ 1423) found no significant correlation of circulating androgen levels with self-reported perception of sexual desire and sexual satisfaction (17). Interestingly, although the majority of women with a low DHEAS did not have low sexual function, a low DHEAS (10th percentile) was still significantly associated with higher odds of impaired sexual function (17). However, no data were provided on circulating levels of biologically active, desulfated DHEA in this cohort.…”

Section: Definition Of Female Androgen Deficiencymentioning

confidence: 92%

Androgen therapy in women

Arlt

2006

eur j endocrinol

104

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Androgens in women either derive from direct ovarian production or from peripheral conversion of the adrenal sex steroid precursor, dehydroepiandrosterone, towards active androgens. Therefore, loss of adrenal or ovarian function, caused by Addison's disease or consequent to bilateral oophorectomy, results in severe androgen deficiency, clinically often associated with a loss of libido and energy. Importantly, physiological menopause does not necessarily lead to androgen deficiency, as androgen synthesis in the ovaries may persist despite the decline in estrogen production. However, the definition of female androgen deficiency, as recently provided by the Princeton consensus statement, is not precise enough and may lead to over-diagnosis due to the high prevalence of its diagnostic criteria: androgen levels below or within the lower quartile of the normal range and concurrent sexual dysfunction. Importantly, physiological menopause is not necessarily associated with androgen deficiency and therefore does not routinely require androgen therapy. Current replacement options include transdermal testosterone administration or dehydroepiandrosterone treatment, both of which have been shown to result in significant improvements, in particular in libido and mood, while effects on body composition and muscular function are not well documented. It is important to keep in mind that the number of randomized controlled trials is still limited and that currently none of the available preparations is officially approved for use in women. Currently, androgen replacement should be reserved for women with severe androgen deficiency due to an established cause and matching clinical signs and symptoms.

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Section: Definition Of Female Androgen Deficiencymentioning

confidence: 92%

Androgen therapy in women

Arlt

2006

eur j endocrinol

104

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“…Two large recent studies failed to find correlation of sexual function with serum androgen levels measured as total testosterone and free androgen index in 2900 pre and perimenopausal multiethnic North American women, 51 and as free and total testosterone in 1021 Australian women aged 18-75 years. 52 Even in 81 women with premature ovarian failure, little correlation was found recently between sexual function and testosterone levels. 53 That there is no consistent relationship between sexual function and any of the prohormones has been well documented.…”

Section: Risk Factors For Sexual Dysfunctionmentioning

confidence: 99%

Women's sexual function and dysfunction: current uncertainties, future directions

Basson

2008

Int J Impot Res

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There is increasing evidence that women at the outset of sexual activity do not need to have sexual desire, as in 'drive', and that many do not distinguish desire from arousal. Multiple modes of investigation confirm poor correlation between women's subjective arousal and measured genital congestion. Suggested revisions to the DSM-IV definitions of sexual disorder have been published: there is now need to align interview assessments and screening questionnaires with contemporary understanding of women's sexual response. Whereas the psychological factors associated with women's sexual function and resilience to biological insults and external stressors are well documented, the role of biological factors is less clear. Variations in the rate of decline of adrenal and ovarian pro-hormones, activity of converting enzymes in peripheral cells, sensitivity of androgen and estrogen receptors and cerebral production of sex steroids may all be involved. Thus there is great complexity underlying the question of sex hormone supplementation, and in particular, little clarity as to which women have decreased brain and/or peripheral androgen activity. When psychosexual etiological factors appear to be minimal and investigational testosterone supplementation is considered, it would be appropriate to target women with disordered arousal and desire in keeping with the recently recommended revised definitions.

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“…Some studies have observed an association between measures of female sexual desire and serum concentrations of total testosterone and free testosterone (3,4), while others could not confirm this (5). Although a biopsychosocial approach to female sexuality remains in order, there seems to be a consensus upon the role of testosterone in motivational aspects of sexuality such as sexual desire (6,7).…”

Section: Introductionmentioning

confidence: 99%

Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels

Elaut¹,

Cuypere²,

Sutter³

et al. 2008

European Journal of Endocrinology

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Objective: An unknown proportion of transsexual women (defined as post-operative male-to-female transsexuals on oestrogen replacement) experience hypoactive sexual desire disorder (HSDD). It has been suggested that the absence of ovarian androgen production together with oestrogen treatmentrelated increase in sex hormone-binding globulin (SHBG) levels could be leading to HSDD, due to low levels of biologically available testosterone. This study wishes to document the HSDD prevalence among transsexual women and the possible association to androgen levels. Design: Cross-sectional study. Methods: Transsexual women (nZ62) and a control group of ovulating women (nZ30) participated in this study. Questionnaires measuring sexual desire (sexual desire inventory) and relationship and sexual satisfaction (Maudsley Marital Questionnaire) were completed. Serum levels of total testosterone, LH and SHBG were measured in blood samples obtained at random in transsexual women and in the early follicular phase in ovulating women. Results: The transsexual group had lower levels of total and calculated free testosterone (both P!0.001) than the ovulating women. HSDD was reported in 34% of the transsexual and 23% of the ovulating women (PZ0.30). Both groups reported similar levels of sexual desire (PZ0.97). For transsexual women, no significant correlation was found between sexual desire and total (PZ0.64) or free testosterone (PZ0.82). In ovulating women, these correlations were significant (PZ0.006, resp. PZ0.003). Conclusions: HSDD is reported in one-third of transsexual women. This prevalence is not substantially different from controls, despite markedly lower (free) testosterone levels, which argues against a major role of testosterone in this specific group.

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Circulating Androgen Levels and Self-reported Sexual Function in Women

Cited by 468 publications

References 30 publications

Androgen therapy in women

Androgen therapy in women

Women's sexual function and dysfunction: current uncertainties, future directions

Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels

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