Female Sexuality - Androgens & Androgen Deficiency, The Hormones of Female Sexual Desire, Part 2 of 4

Androgen Deficiency

There is no agreement amongst the medical community concerning what constitutes androgen deficiency in women, and its roll in sexual dissatisfaction.

The Princeton consensus in 2002 defined it as when a woman meets all three of the following conditions:

1. She believes she is experiencing impaired well-being or libido
2. She has adequate estrogen levels, meaning her ovaries are producing sufficient estrogen or she is on estrogen replacement therapy (ERT)
3. She has blood levels of androgens that are less than or equal to 25% of the normal or average amount. If the average amount is 100, then measured values of 0-25 meet this condition.

The Sexual Function Health Council of the American Foundation for Urologic Disease (AFUD) defined Hyposexual Desire Disorder (HSDD) as when the following two conditions exist at the same time:

1. Continuous or recurrent experiences of decreased frequency of or absent sexual fantasies, thoughts and/or desire for or willingness to engage in sexual activity. Basically, little or no sexual feelings or motivations.
2. The existence of the first condition leads to person distress. Meaning you are very unhappy because you are not experiencing sexual feelings or desires as often as you would like or believe you should.

Some find fault with the use of any diagnosis that cannot be verified in a medical lab with proven tests, and verifiable results, which is any diagnosis a women determines for herself. Since medical science has not found a clear link between the majority of self reported cases of low sexual desire and measurable androgen deficiencies, this is to be expected. Though women are understandably frustrated by the medical community's apparent lack of action when it comes to resolving their lack of sexual desire, and decreased quality of life.

One study found that having low DHEAS levels did not automatically lead to women reporting lower sexual satisfaction, but women who reported having impaired sexual function were more likely to have a low DHEAS level. The question becomes, do some women experience decreased sexual desire without knowing, or are low DHEAS levels unrelated to sexual desire? Keep in mind that in the past, and to varying degrees today, society said women don't experience innate sexual desire, that they engage in sex for purely non-sexual motives; maternal instinct, love, partner's needs, intimacy, etc. This means women may not be concerned with an absence of purely sexual motives, especially older generations.

Women may also expect their desire for sex to decrease with age, meaning their decreased desire is to be expected, and is normal, and therefore not a reason for concern; it just is. If sexual desire leads to sex, pregnancy, and more children, you may be happy to no longer experience it. If sexual desire leads to sexual frustration, you may be more than happy to do without. A woman may not believe she is experiencing decreased sexual desire until outside forces, partner's sexual demands and the mass media, lead her to believe otherwise. These factors may explain why women and their doctors do not agree when it comes to explaining and treating sexual dissatisfaction, and specifically low sexual desire.

Why then do women routinely experience increased sexual desire when they are prescribed androgens, specifically testosterone? One possible answer is the fact that the prescribed dosages often raised a woman's level of testosterone to above average levels; lower dosages do not appear to have the same affect. It seems possible that you can raise a woman's level of sexual desire to a point that it overcomes other factors that are the true cause for the low desire, specifically environmental factors. If you ring a woman's sexual bell loud enough, she cannot help but hear it. This scenario becomes a real possibility when one considers the fact that women frequently do not perceive their true level of physical sexual arousal when they are exposed to sexual stimulus. The problem with too much testosterone is that it has undesired side affects.

The following is a list of conditions and causes that may lead to some degree of androgen deficiency.

Low androgen levels may be indicated by:

- Diminished feelings of well-being
- Lethargy (exhaustion, low energy)
- Loss of sex drive and interest
- Unexplained fatigue
- Reduced motivation, pubic hair, and bone and muscle mass
- Poor quality of life
- Problems with blood vessel constriction and dilation
- Insomnia
- Depression
- Headaches

Low androgen levels may be caused by:

- Increasing age²
- Low ovarian output caused by medical factors or surgical removal of the ovaries
- Low adrenal gland output
- Hypopituitarism²
- Glucocorticoid therapy² (Used to treat asthma and rheumatic diseases.)
- Use of oral contraceptives and oral estrogens²- Addison's disease⁴
- Corticosteroid therapy⁴
- Chronic illness⁴
- Chronic stress⁶
- Estrogen replacement (leads to elevated SHBG and, therefore, low free testosterone)⁴
- Premenopausal ovarian failure⁴
- Oophorectomy⁴ (Removal of the ovaries)
- Progestin; cyproterone or drospirenone used in oral contraceptives⁶

Low androgen levels may be associated with³:

- Osteoporosis
- Obesity
- Type 2 diabetes
- Sexual dysfunction
- Loss of muscular strength
- Turner's syndrome⁶

Treatment of Androgen Deficiency

Note: A summary of the current state of Testosterone Replacement Therapy in Naturally and Surgically Menopausal Women, as of January 2009, is available online from the Journal of Sexual Medicine. Medical terminology is used in the article so you may have to discuss what is stated with your doctor, to gain a full understanding. Online medical dictionaries are also available if you want to read the article for yourself.

It is now believed that decreasing DHEA levels may account for some of the symptoms associated with androgen deficiency, rather than the measurable decrease in the other four types of androgens found in the blood. This is because the amount of androgens in the blood does not accurately reflect the total amount of androgens in the tissues of the body. This may explain why current research has not found a clear correlation between the amount of androgens in the blood and female sexual dissatisfaction. I am not aware of research that has looked for or found a specific correlation between DHEA and sexual dissatisfaction, as of November 2006.

Studies have found that when women experiencing adrenal insufficiency took 50mg of DHEA daily, it brought their levels of androgens and estrogens up to normal premenopausal levels, "without significant side affects." DHEA can also be administered in the form of a topical cream. DHEA is available without a prescription, but such products are not under Food and Drug Administration (FDA) control. A study conducted in 1998 found that over the counter products that were said to contain 25mg of DHEA actually had anywhere between 0 and 140 mg; partial testing results from 2006 can be seen by clicking here.

If a woman chooses to take DHEA, it is highly advisable for her to consult her doctor so they can monitor her hormone levels to ensure they increase to the desired levels without becoming too high. The use of DHEA is believed to avoid some of the adverse side affects associated with Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy (HRT), because the resulting increased hormone levels in the tissues are not circulating throughout the body in the blood stream, where they can affect tissues and organs in undesired ways. I would caution women against taking DHEA unless laboratory testing has indicated their androgen levels are significantly lower than they should be.

You can learn more about DHEA, as a medical treatment, at the following web sites:

http://www.mayoclinic.com/health/dhea/NS_patient-dhea

http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-dhea.html

The Brain's Roll

As of August 2011, early indications are the brain of some women, who experience sexual dissatisfaction/dysfunction, process sexual stimulation, visual and clitoral, differently than those who do not. Unfortunately, we do not know if the cause is genetic, organic, or environmental, and I believe treatment is just as elusive. This data may represent the first measured physical manifestation of the "wall." Read the Associated Medical Article Abstracts

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