Is There a Correlation Between Androgens and Sexual Desire in Women?
Sarah Wåhlin-Jacobsen, MD; Anette Tønnes Pedersen, MD, PhD; Ellids Kristensen, MD; Nanna Cassandra Læssøe, MD; Marika Lundqvist, MSc; Arieh S. Cohen, MSc, PhD; David M. Hougaardm MD, Dr.Med; and Annamaria Giraldi, MD, PhD
ONLINE: December 5, 2014 – The Journal of Sexual Medicine
For women worldwide, low sexual desire is the most commonly reported sexual problem. The role of testosterone and that of hormone therapy (HT) have been studied, but results have not been conclusive or consistent.
Researchers have since examined why these results have been mixed. This has led to the development of validated questionnaires and the use of mass spectrometry for the analysis of steroids.
Because the amount of bioactive testosterone can be difficult to measure, some experts believe that assessing levels of androsterone glucuronide (ADT-G) may be the more accurate way to evaluate bioactive androgens.
Also considered is the enzyme 17b-hydroxysteroid dehydrogenase, which may also be involved in women’s androgen levels. However, this enzyme has not been studied in regard to women’s sexual desire.
In this study, the researchers questioned whether levels of circulating androgens (including ADT-G) and 17b-hydroxysteroid dehydrogenase activity would correlate with sexual desire in women overall and at certain life stages.
The study had four aims:
• To evaluate a possible correlation between androgens and sexual desire in healthy women, taking into account the use of hormonal contraceptives (HC) and postmenopausal hormone therapy.
• To investigate whether ADT-G levels are better correlated to sexual desire than the level of circulating androgens.
• “To examine the correlation between sexual desire and the ratio between androstenedione and total testosterone as an estimate of the activity of 17b-hydroxysteroid dehydrogenase as an indication of the speed of the transformation of androstenedione to testosterone.”
• “To evaluate age-dependent changes in hormone levels and sexual desire in pre- and postmenopausal women without any use of systemic HC or HT.”
Five-hundred sixty women between the ages of 19 and 65 were included in the study. They were divided by age into three groups: 19-24 years, 25-44 years, and 45-65 years. The groups were formed so that researchers could investigate the correlation of androgens and sexual desire at different life stages.
The participants were also divided by menopausal status. Perimenopausal women were grouped with postmenopausal women.
This study had a cross-sectional design. Data were collected from April 2009 until November 2010. This process was coordinated with the women’s menstrual cycles. For consistency, data were obtained between 3 pm and 6 pm.
The women’s height and weight were measured along with their chest, hip, and waist circumference. Blood pressure was also assessed. Each woman gave a blood sample and completed the Female Sexual Function Index (FSFI). Demographic questions were answered as well.
Main Outcome Measures
The following outcome measures were used:
|Sexual Desire||Sexual desire domain of the FSFI, based on a woman’s experiences from the previous four weeks. Women who score 5 points or less on this domain are considered at “high risk” for hypoactive sexual desire disorder (HSDD).|
|Steroid Analyses||Liquid chromatography (LC)-mass spectrometry|
|17b-hydroxysteroid dehydrogenase activity||Defined as the speed of the transformation from androstenedione to testosterone. Estimated as the ratio between the level of androstenedione and total testosterone in the blood.|
The women’s mean age was 36.4 years. Approximately 78% of the women were premenopausal. About 40% used hormonal contraception. Postmenopausal hormone therapy was used by 4.5%.
For the entire population, a statistically significant correlation was found between sexual desire and free testosterone and androstenedione after age adjustment.
For women aged 19-24 years, total testosterone and free testosterone were positively correlated with sexual desire.
In women aged 25-44 years, total testosterone and dehydroepiandrosterone (DHEAS) were positively correlated with sexual desire.
In women aged 45-65 years, androstenedione and the androstenedione : total testosterone ratio were positively correlated with sexual desire.
ADT-G was not correlated with sexual desire in any of the three age groups.
For women who did not take systemic HC:
• Positive correlations were found between sexual desire and total testosterone, free testosterone, androstenedione, and DHEAS in women in women aged 25-44 years.
• In women aged 45-65 years, androstenedione and the androstenedione : total testosterone ratio were correlated with sexual desire.
For the women aged 19-24 years and those who did use systemic HC, androgens and ADT-G were not significantly correlated with level of sexual desire.
In premenopausal women who did not use any systemic HC, levels of total and free testosterone, androstenedione, and DHEAS declined with age.
Age-related declines in DHEAS and the androstenedione : total testosterone ratio were seen in postmenopausal women.
ADT-G levels did not correlate with age in either premenopausal or postmenopausal women.
Also in premenopausal and postmenopausal women, sexual desire declined significantly with age.
To the authors’ knowledge, this study was “the first to find such strong correlations” between serum androgen levels and sexual desire.
The correlations found in this study confirm the hypothesis that female sexual function could be affected by levels of testosterone precursors.
Among these study subjects, the correlation between circulating androgens and sexual desire were most significant in women aged 25-44 years.
The authors noted that their findings “could reflect the fact that many other factors are important for women’s sexuality.” Examples include losing a partner, sickness, a partner’s sexual dysfunction, menopause, or problems with sexual pain, lubrication, or anorgasmia.
However, middle-aged women tend to be in more stable relationships, so biological factors may play a stronger role in their sexual desire.
The researchers did not find a statistically significant correlation between ADT-G and sexual desire. “This finding could be explained by the fact that the level of ADT-G primarily represents the level of DHEAS and does maybe underestimate the total biosynthesis of androgens.”
“Therefore, based on these current and previous results, we cannot conclude that ADT-G is a better biomarker of the link between androgens and women’s sexual desire than measuring the amount of circulating androgens,” they added.
They also noted that the androstenedione : total testosterone ratio was correlated overall with women’s sexual desire in women not using systemic HC or HT. This suggests “that the speed of transformation of androstenedione to testosterone is important.”
It’s possible that 17b-hydroxysteroid dehydrogenase affects the potential of androgens. This may be addressed in future research.
Strengths and Limitations
According to the authors, the biggest strength of the study was its large number of participants, which included women who did and did not take HC or HT. This consideration “represents the clinical reality,” they said. They also noted that using the FSFI sexual desire domain scores allowed them to include women who were not sexually active.
Noted limitations included:
• The study subjects were volunteers who might not represent the background population.
• Because of budget constraints, the women’s ovulatory cycles were not examined.
• The study included women with medically untreated depression, which could have affected their levels of sexual desire.
• Other biological, social, and psychological factors can affect sexual desire as well.
• The study’s cross-sectional design did not allow the researchers to draw conclusions about causation.
• There is no way to know whether declines in sexual desire were caused by aging or “changes in culture and norms over time.”
The authors recommended an individual and multidisciplinary approach for diagnosing and treating women with low sexual desire. Mass spectrometry should be used only to confirm a suspected androgen deficiency or to monitor testosterone treatment. Clinicians should keep in mind that androgen levels fluctuate during a woman’s menstrual cycle.