Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women∗

Abstract

Introduction The female sexual response is complex and influenced by several biological, psychological, and social factors. Testosterone is believed to modulate a woman's sexual response and desire, because low levels are considered a risk factor for impaired sexual function, but previous studies have been inconclusive. Aim To investigate how androgen levels and psychosocial factors are associated with female sexual dysfunction (FSD), including hypoactive sexual desire disorder (HSDD). Methods The cross-sectional study included 428 premenopausal women 19 to 58 years old who completed a questionnaire on psychosocial factors and had blood sampled at days 6 to 10 in their menstrual cycle. Logistic regression models were built to test the association among hormone levels, psychosocial factors, and sexual end points. Main Outcome Measures Five different sexual end points were measured using the Female Sexual Function Index and the Female Sexual Distress Scale: impaired sexual function, sexual distress, FSD, low sexual desire, and HSDD. Serum levels of total and free testosterone, androstenedione, dehydroepiandrosterone sulfate, and androsterone glucuronide were analyzed using mass spectrometry. Results After adjusting for psychosocial factors, women with low sexual desire had significantly lower mean levels of free testosterone and androstenedione compared with women without low sexual desire. None of the androgens were associated with FSD in general or with HSDD in particular. Relationship duration longer than 2 years and mild depressive symptoms increased the risk of having all the sexual end points, including FSD in general and HSDD in particular in multivariate analyses. Conclusion In this large cross-sectional study, low sexual desire was significantly associated with levels of free testosterone and androstenedione, but FSD in general and HSDD in particular were not associated with androgen levels. Length of relationship and depression were associated with FSD including HSDD.

Women’s sexual dysfunction associated with psychiatric disorders and their treatment

“…Psychiatric disease is the most important risk factor for women's sexual dysfunction. [1][2][3][4] This remains true in the context of chronic diseases known to interrupt the neurovascular basis of sexual physiology. Thus, depression, rather than the burden of physical disease or severity of complications, is the independent factor determining presence or absence of sexual dysfunction in women living with diabetes, 5 multiple sclerosis, 6 renal failure 7 or rheumatic disease 8 as well as those with a history of past childhood sexual abuse.…”

The Potential of Hormonal Contraception to Influence Female Sexuality

“…However, this cycle of responses must be understood within an intrapersonal and interpersonal context. As previously mentioned, factors as depression or the length of relationship have been associated with FSD [8, 9]. For many women, the contemporary phases of the sexual response cycle may vary in sequence, overlap, repeat, or even be absent, during all or some sexual encounters [7, 8].…”

“…Significant increases in libido and in sexual frequency were seen in postmenopausal women who received weekly intramuscular injections of testosterone [11]. Sexual desire was significantly associated with levels of free testosterone (FT) and androstenedione in premenopausal women, but FSD in general was not associated with androgen levels [9]. A population-based study of over 1400 randomly selected women aged 18 to 75 years showed no single androgen level to be predictive of low sexual function [12].…”

International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women

“…85 Early follicular phase levels of total and free testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEA-S) have been positively correlated with self-reported sexual desire in premenopausal women aged 25-44 years not using hormonal contraception, 83 whereas no correlation was found in women with HSDD. 86 A recent study of women aged 18-39 years, with regular menstrual cycles, not using any sex steroid therapy who had sex steroids measured by LC-MS/MS, found weak positive associations between both sexual desire and sexual pleasure and DHEA and androstenedione. 84 Orgasm was positively correlated with both testosterone and androstenedione.…”