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Sex Hormone Levels Ruled Out As Cause for Low Sexual
Function in Women
July 6, 2005 A study of adult women up to age 75
found no sex hormone (androgen) level that predicts low sexual function
in women, as had been assumed to be a significant independent
determinant of sexual behavior in women.
The androgens include testosterone, which has been
associated with improved sexual function for some women. But the
Australian research says that levels of androgens, or male sex hormones,
in a woman's blood don't reflect her sexual function.
Sexual dysfunction, primarily low libido, is common
among women, with prevalences of 8 percent to 50 percent, according to
background information in the article in todays issue of JAMA.
Although multiple psychosocial and health factors
contribute to low sexual desire and arousal, it has been proposed that
androgen levels are significant independent determinants of sexual
behavior in women. It is widely believed that a low serum free
testosterone level is the diagnostic marker for the cluster of symptoms
described as characterizing female androgen insufficiency based on
therapeutic trials, and expert opinion.
However, evidence that a low serum testosterone
level distinguishes women with low sexual function from others, is
lacking, the study says.
Susan R. Davis, M.D., Ph.D., of Monash Medical
School, Alfred Hospital, Victoria, Australia, and colleagues conducted a
study to determine if low self-reported sexual function is associated
with low serum androgen levels. The study included 1,423 women aged 18
to 75 years who were randomly recruited from April 2002 to August 2003.
Women were excluded from the analysis if they were
younger than 45 years and using oral contraception. This would indicate
the participants were primarily baby boomers and senior citizens.
Women were surveyed with the Profile of Female
Sexual Function (PFSF) and serum levels of total and free testosterone,
androstenedione (an androgenic steroid), and dehydroepiandrosterone
sulfate (DHEAS, a natural steroid hormone) were measured.
The researchers write: We found no evidence of
associations between low scores for any of the sexual domains evaluated
and low serum total and free testosterone levels. In contrast, we
observed significant associations between low sexual desire, arousal,
and responsiveness in younger women [aged 18 to 44 years] and low
responsiveness in older women [aged 45 years or older] and low serum
DHEAS level relative to age.
What they concluded is the DHEAS level had no
direct bearing on libido.
"There's a relationship between hormones and sexual
well-being but there's no hormonal cut-off point that defines
dysfunction," said Davis.
She says while researchers are still waiting on safety data, current
scientific evidence indicates that treatment with testosterone can help
women with a poor libido.
Davis says testosterone can be considered as a treatment if no other
obvious causes of sexual dysfunction can be found.
In addition to demonstrating that the measurement
of testosterone is not useful for the diagnosis of the proposed female
androgen insufficiency syndrome, our findings also do not support a
diagnostically useful role for the measurement of DHEAS. This is because
despite the increased likelihood that women with low sexual function
have a low DHEAS level, the majority of women with a low DHEAS level did
not report low sexual function, the authors write.
Our results are not in conflict with testosterone
being used pharmacologically to treat [abnormally inactive] sexual
desire disorder, nor do they provide support for efficacy of DHEA
therapy. Rather, our data, taken together with what is already known
about the intracrine [a type of hormone function] physiology, suggest
that sex steroids influence female sexual function, but that there is no
serum androgen level that defines female androgen insufficiency. The
measurement of serum testosterone, free testosterone, or DHEAS in
individuals presenting with low sexual function is not informative and
levels of these hormones should not be used for the purpose of
diagnosing androgen insufficiency in women, the researchers conclude.
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