Magazine article Clinical Psychiatry News

Regular Periods Don't Rule out Low Testosterone. (Low Libido in Women)

Magazine article Clinical Psychiatry News

Regular Periods Don't Rule out Low Testosterone. (Low Libido in Women)

Article excerpt

MONTREAL -- Physicians who see young women complaining of low libido should consider that the problem could be low testosterone even if the women have regular menstrual periods.

That advice was offered by several experts in female sexual dysfunction (FSD) at the 10th World Congress of the International Society for Sexual and Impotence Research,

"Faced with this complaint of low libido from a young female patient, most physicians don't even consider looking at hormones. In fact, if the woman is having regular periods, they consider this proof that her hormones are fine," said Dr. Andre Guay, an endocrinologist and director of the Center for Sexual Function Endocrinology in Peabody, Mass.

Physicians may mistakenly assume that if a woman has regular periods, her testosterone production must be normal. But women get only half of their testosterone from their ovaries and the other half from their adrenals. Consequently, even though ovarian function might be normal, decreased adrenal function could result in low levels of testosterone.

"You have to recognize the two different steroid pathways for female testosterone production. For years, we've known that 40% of women who take the birth control pill have low libido, which makes sense because what you're doing with the birth control pill is that you're shutting off the ovary, so you're losing half your testosterone production. On the other hand, in women who have asthma or lupus and who are taking steroids, you are shutting off the adrenals, which is the other half of their testosterone production. So there are a lot of clinical conditions, especially in premenopausal women, where you shut off one or the other or even both of these sources of testosterone," he said in an interview

In a study conducted by Dr. Guay of premenopausal women aged 20-49 years who had regular menstrual periods, 18 had a diagnosis of FSD, and another 18 had normal sexual function. At baseline, women with FSD had significantly decreased levels of testosterone and adrenal androgen precursors (dehydroepiandrosterone-sulfate or DHEA-S) but not ovarian androgen precursors (androstenedione), compared with women with normal sexual function.

When the women were given an ACTH stimulation challenge, both women with and without FSD responded to the test, indicating that the adrenal glands respond normally in women with FSD, but there may be a possible defect in the steroid synthesis chain, he said.

In another study presented at the meeting, Dr. Ricardo Munarriz retrospectively reviewed all patients with FSD and adrenal insufficiency who were treated with DHEA supplementation at his clinic, the Institute for Sexual Medicine at Boston University

In a sample of 136 women, mean age 37 years, with an average of 13 years duration of FSD symptoms, scores on the Sexual Distress Scale were significantly improved (from 35. …

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