Impact of Oral Contraceptives on Sex Hormone-Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction

Abstract

Introduction Oral contraceptives (OCs) have been the preferred method of birth control because of their high rate of effectiveness. OC use, however, has been associated with women's sexual health complaints and androgen insufficiency. OC use is associated with a decrease of androgen ovarian synthesis and an increase in the production of sex hormone-binding globulin (SHBG). There have been limited studies assessing SHBG values after discontinuation of OC use. Aim To retrospectively investigate SHBG levels before and after discontinuation of OC use. Main Outcome Measure Sex hormone-binding globulin values were compared at baseline, while on the OC, and well beyond the 7-day half-life of SHBG at 49–120 (mean 80) days and >120 (mean 196) days after discontinuation of OCs. Methods A total of 124 premenopausal women with sexual health complaints for >6 months met inclusion/exclusion criteria. Three groups of women were defined: (i) “Continued-Users” (N = 62; mean age 32 years) had been on OCs for >6 months and continued taking them; (ii) “Discontinued-Users” (N = 39; mean age 33 years) had been on OCs for >6 months and discontinued them; and (iii) “Never-Users” (N = 23; mean age 36 years) had never taken OCs. Results Sex hormone-binding globulin values in the “Continued-Users” were four times higher than those in the “Never-User” group (mean 157 ± 13 nmol/L vs. 41 ± 4 nmol/L; P < 0.0001). Despite a decrease in SHBG values after discontinuation of OC use, SHBG levels in “Discontinued-Users” remained elevated in comparison with “Never-Users” (N = 26; P < 0.0001 for >120 days). Conclusion In women with sexual dysfunction, SHBG changes in “Discontinued-Users” did not decrease to values consistent with “Never-Users.” Long-term sexual, metabolic, and mental health consequences might result as a consequence of chronic SHBG elevation. Does prolonged exposure to the synthetic estrogens of OCs induce gene imprinting and increased gene expression of SHBG in the liver in some women? Prospective research is needed.

Inaccurate First-Generation Testosterone Assays Are Influenced by Sex Hormone–Binding Globulin Concentrations

“…In this study, we showed that pregnant women and women using OAC have higher SHBG concentrations (6-and 2-fold, respectively). This confirms the results from previous studies, showing a 5-to 10-fold increase during pregnancy (13,14) and a 2-to 4-fold increase in women using OAC (15,16), which is due to estrogens stimulating the liver to produce SHBG. Increased serum SHBG concentrations are also seen in samples from patients with anorexia nervosa, hyperthyroidism, and Cushing disease (17).…”

Correlates of Sexual Satisfaction Among Sexually Active Postmenopausal Women in the Women’s Health Initiative-Observational Study

“…Detrimental effects of oral contraceptives on sexual functioning may be sustained after discontinuation of the medications. 37 However, removal of this variable from the final model with addition of the sexual frequency construct suggests this finding lacks robustness. There was no difference between current and never smokers in sexual satisfaction.…”

An Evolutionary Approach Offers a Fresh Perspective on the Relationship Between Oral Contraception and Sexual Desire

“…Furthermore, even though several questionnaires contain items relating to partner-focused sexual satisfaction, which is likely correlated with desire, these items are often subsumed within global sexuality scores or in desire subscales which also incorporate general sexual desire (e.g., Panzer et al, 2006;Wallwiener et al, 2010).…”

“…It is perhaps remarkable that several studies fail to do this (e.g. Fortenberry & Hensel, 2011;Panzer et al, 2006). Even in those that do, including many who specifically recruit partnered women, few record changes in relationship status across the study.…”