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

Abstract

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.

Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals

“…Nevertheless, an earlier study reported that while self-reported decreased sexual desire was experienced in one-third of a group of 62 MTF individuals, this level was similar to a group of pre-menopausal female controls [66]. A subsequent study of MTF individuals with self-reported decreased sexual desire began a testosterone patch used to treat decreased sex drive in cisgender women.…”

Continuing Medical Education: Sexual Functioning in Transsexuals Following Hormone Therapy and Genital Surgery: A Review (CME)

“…However, in contrast to the literature on sexual desire and testosterone in natal women [40–44], this study found no significant relationship between testosterone levels and sexual desire in MtF transsexuals. In their sample of natal women, a significant positive correlation was found between solitary—but not dyadic—sexual desire and total and free testosterone [74]. Thus, MtF transsexuals appear to be a unique population in their apparent dissociation between androgen levels and sexual desire.…”

“…Whereas the prediction regarding sexual desire in transsexual participants was not realized, a prediction that testosterone levels would be significantly lower in transsexual participants as a result of cross‐sex hormone therapy was supported [74]. Specifically, both total testosterone and calculated free testosterone were significantly lower in MtF transsexuals as compared to the natal women.…”

Sexual desire in female-to-male transsexual persons: exploration of the role of testosterone administration

“…While levels of free testosterone in the group of maleto-female transsexual persons were markedly lower, the intensity and frequency of sexual desire was very similar to control women not using hormonal contraception. These findings argue against a major role of testosterone in the sexual desire in male-to-female transsexuals (5). In a pilot study, Kronawitter et al (6) treated hypoactive sexual desire in male-to-female transsexual persons with a testosterone patch.…”