In the mood for sex: The value of androgens

Androgen substitution is increasingly being employed to enhance sexual desire in women based on the assumption that low androgen levels cause low sexual desire, Sexual functioning in women is complex; therefore, decreased sexual interest can have various causes. An adequate female sexual biopsycbosocial model that includes the role of androgens has not yet been developed. Moreover, a higher or lower degree of sexual desire does not form a measure for sexual satisfaction. One group of women at risk for androgen deficiency are women with pathophysiological problems that affect androgen production in the ovaries and/or adrenal glands. The available literature indicates that androgen substitution, despite leading to supraphysiological androgen levels, improves some aspects of sexual functioning, especially in women who have undergone oophorectomy. What this means in terms of satisfaction with sexual functioning in these women is not clear. We believe that, from an evidence-based point of view, testosterone substitution should only be administered as adjuvant treatment to sexological counseling in women with low libido in combination with low bioavailable androgen levels because of insufficiency of ovarian and/or adrenal function and normal estrogen levels. The routine administration of androgens to endocrinologically healthy women who have complaints of decreased sexual interest is not based on available evidence

Decreased androgen concentrations and diminished general and sexual well-being in women with premature ovarian failure

Objective: To describe general and sexual well-being in women with premature ovarian failure (POF) and to investigate whether there is a relationship between androgen levels and sexual functioning. Design: Women with POF and healthy volunteers with regular menstrual cycles participated. Participants completed a written questionnaire and underwent hormonal screening. The questionnaire included standardized measures: the Questionnaire for Screening Sexual Dysfunctions, the Shortened Fatigue Questionnaire, and the Symptom Check List-90. Serum hormone measurements included estradiol, total testosterone, bioavailable testosterone, androstenedione, dehydroepiandrosterone, and dehydroepiandrosterone sulfate. Results: Eighty-one women with POF and 68 control women participated in the study. Compared with control women, women with POF reported more complaints of anxiety, depression, somatization, sensitivity, hostility, and psychological distress. Overall women with POF were less satisfied with their sexual life. They had fewer sexual fantasies and masturbated less frequently. Sexual contact was associated with less sexual arousal, reduced lubrication, and increased genital pain. However, the frequency of desire to have sexual contact and the frequency of actual sexual contact with the partner did not differ between women with POF and control women. Women with POF had lower levels of estradiol, total testosterone, and androstenedione. Multiple regression analysis revealed that androgen levels had only a weak influence on sexual functioning; higher total testosterone levels were associated with increased frequency of desire for sexual contact, and higher androstenedione levels were associated with elevated frequency of sexual contact. Conclusions: Women with POF have diminished general and sexual well-being and are less satisfied with their sexual lives than control women. Although women with POF had lower androgen levels, we did not find an important independent told for androgens in various aspects of sexual functioning