Levels of Male Hormones Not Predictive of Sexual Function in Women
Androgens, such as testosterone, androstenedione, and dehydroepiandrosterone sulfate, are male sex hormones, responsible for the development and maintenance of masculine characteristics, including the deepening of the voice during puberty and the production of sperm. While these hormones are most recognized for their functions in men, women produce them too.
The production of androgens in women begins to decline during ]]>menopause]]> , when many women experience low libido and other problems with sexual function. Some studies have indicated that testosterone replacement therapy may be beneficial in restoring sexual desire in women. As a result, an increasing number of physicians are prescribing testosterone to their female patients to treat sexual dysfunction.
But a new study in the July 6, 2005 issue of the Journal of the American Medical Association looked at about 1,000 women and found that blood levels of androgens were not predictive in identifying women with sexual dysfunction.
About the Study
This study included 1,021 women ages 18-75, who were randomly selected from an electoral roll database in Victoria, Australia. Women who took psychiatric medication, had abnormal thyroid function, had documented polycystic ovarian syndrome, were using birth control pills, or were pregnant or less than six weeks postpartum were not included.
On the day of the study, the women provided fasting blood samples and answered a questionnaire designed to measure low sexual desire and related symptoms. The researchers measured the participants’ blood levels of the following androgens: total and free testosterone, androstenedione (a precursor to testosterone), and dehydroepiandrosterone sulfate (DHEAS, a natural steroid hormone). The questionnaire assessed seven domains of desire: arousal, orgasm, pleasure, sexual concerns, responsiveness, and self-image.
The researchers found there was no clinically useful association between low total or free testosterone or androstenedione levels and low sexual function.
On the other hand, DHEAS was a slightly better marker for some sexual problems measured by the study questionnaire. Older women with markedly decreased sexual responsiveness had lower DHEAS levels than did women who reported lesser or no difficulties with response. For more prevalent sexual problems (decreased desire, decreased arousal, decreased pleasure, problems with orgasm) the DHEAS level was not a useful predictor among women over 45. In younger women (18-44) low DHEAS levels did correlate with the most severe degrees of sexual dysfunction in three of the six domains measured by the questionnaire (desire, arousal, and responsiveness). However, most women with low DHEAS levels did not have low sexual function.
How Does This Affect You?
Many women (and their doctors) may be uncertain about what constitutes “abnormal sexual function”. This study does little to answer that question. The study does confirm that when asked about their sexual functioning women of all ages give widely-differing self appraisals.
When sexual dysfunction is measured by the “Profile of Female Sexual Function Questionnaire” used in this study, blood testosterone measurements do not correlate with the results. Even DHEAS levels (which do correlate somewhat) are of minimal diagnostic value. For example, 80% of younger women with low DHEAS levels reported normal sexual responsiveness (according to the study’s criteria). Having a “normal” DHEAS level wasn’t much more useful: it reduced the likelihood of scoring low in sexual responsiveness from 5% to 4%.
This study may discourage doctors from ordering expensive laboratory testing for most women who report difficulties in sexual function. However, the study has many limitations. Chief among these is that of the more than 15,000 women invited to participate, only 1,021 completed the study. We cannot know whether the 14,000 who dropped out or were excluded might have been different from those who actually participated—or from you.
The causes of low libido and other forms of female sexual dysfunction are complex and involve many factors. Even though doctors remain uncertain about the causes of this condition, new drugs are being developed and marketed to treat female sexual dysfunction. If you are having problems with libido or other sexual functioning, talk to your doctor. Psychological problems can sometimes contribute to sexual dysfunction; effective treatment of these can make a big improvement in all of your functioning—not just in your sexual life. A medical condition or side effects from a medication may also be a treatable cause of your problem. If these problems are excluded and sexual dysfunction remains a troubling problem in your life, medical treatment may prove effective.
Sexual Information and Education Council of the United States
The Endocrine Society
Androgen deficiency in women: review of the subject. American Family Physician website. Available at: http://www.aafp.org/afp/20011215/tips/6.html . Accessed July 12, 2005.
Davis SR, Davison SL, Donath S, Bell RJ. Circulating androgen levels and self-reported sexual function in women. JAMA . 2005;294:91-96.
Female sexual problems. American Association of Marriage and Family Therapy website. Available at: http://www.aamft.org/families/consumer_updates/femalesexualproblems.asp . Accessed July 12, 2005.
Last reviewed July 14, 2005 by ]]>Larry Frisch, MD, MPH]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.