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No link found between low androgen
levels and low sexual function in womenJuly 06, 2005 No single
androgen (sex hormone) level was found to be predictive of
low sexual function in women, according to a study in the
July 6 issue of JAMA. Sexual dysfunction, primarily low libido,
is common among women, with prevalences of 8 percent to 50
percent, according to background information in the article.
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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. 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. 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.
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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." "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.
JAMA and Archives Journals
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