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Role of androgens in women's sexual dysfunction

Basson, Rosemary MD, FRCP(UK)1; Brotto, Lori A. PhD2; Petkau, A. John PhD3; Labrie, Fernand MD, PhD4

doi: 10.1097/gme.0b013e3181d59765
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Objective: Although suspected, androgen deficit in women with sexual dysfunction has never been established. Given that serum testosterone levels are of limited value, we sought to compare total androgen activity in women with and without hypoactive sexual desire disorder (HSDD). Intracellular production in target tissues is the major source of testosterone in older women and can now be measured. Androgen metabolites, specifically androsterone glucuronide (ADT-G), reflect intracellular and ovarian sources of testosterone. Thus, we predicted significantly lowered levels of metabolites in women with sexual dysfunction.

Methods: A detailed assessment of the sexual function of women without depression, without serious relationship discord, or receiving medications affecting sexual function included 121 women with HSDD and 124 sexually healthy community controls. Sexual function was assessed using structured interviews, validated questionnaires, and steroid analysis-mass spectrometry levels of ADT-G, testosterone, and precursor hormones.

Results: No group differences in serum levels of testosterone or ADT-G were found. Significantly lower levels of two precursor hormones, dehydroepiandrosterone sulfate and androstene-3β,17β-diol, were found in women with sexual dysfunction (P = 0.006 and P = 0.020, respectively). The variability of metabolite and precursor levels was substantial for all women.

Conclusions: Significantly lower levels of the two precursor steroids dehydroepiandrosterone sulfate and androstene-3β,17β-diol but not the major androgen metabolite ADT-G were found in women with HSDD. Although the significance of the former awaits further study, androgen deficiency in women with HSDD was not confirmed. Given the unknown long-term effects of testosterone supplementation, women receiving testosterone therapy should be informed that a deficit of testosterone activity in women with HSDD has not been identified.

Androgen metabolites, specifically androsterone glucuronide, reflect intracellular and ovarian sources of testosterone. In this study, it was predicted that women with sexual dysfunction had significantly lowered levels of metabolites. Significantly lower levels of two precursor steroids but not a major androgen metabolite were found in women with hypoactive sexual desire disorder.

From the 1Department of Psychiatry, Vancouver Hospital, and Departments of 2Obstetrics and Gynaecology, and 3Statistics, University of British Columbia, Vancouver, British Columbia, Canada; and 4Research Center in Molecular Endocrinology, Oncology and Human Genomics, Laval University and Laval University Hospital (CHUL), Quebec, Canada.

Received December 4, 2009; revised and accepted January 19, 2010.

All authors contributed to the design and implementation of the study, interpretation of the data, and writing of the manuscript. Data analysis was conducted primarily by Mr. Feng Zhu, under the supervision of Dr. Petkau. Although all authors had full access to the data in the study, Dr. Brotto takes responsibility for the integrity of the data; and Dr. Petkau, for the accuracy of the data analysis. Steroid measurements were performed by Dr. Labrie.

Funding/support: This study was supported by an operating grant from the Canadian Institutes of Health Research.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Rosemary Basson, MD, FRCP(UK), BC Centre for Sexual Medicine, Vancouver Hospital, 855 West 12th Ave., Vancouver, BC, Canada V5Z 1M9. E-mail: sexmed@interchange.ubc.ca

©2010The North American Menopause Society