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Androgen Insuffiency in Women

Circulating androgens are found in much higher concentrations than estrogens, and are involved in a variety of biochemical and physiological functions. Androgen insufficiency syndrome, characterized by low libido, decreased arousal, orgasm, motivation, lack of well being, fatigue, adequate estrogen level, and low androgen levels, is thought to be responsible for up to 30-50% of the cases of sexual dysfunction in women.

Numerous studies have described and clarified the effect of androgens in male sexuality. It is only recently, however, that studies have been performed to illustrate the equally important action of androgens on the sexual functioning of women. In women androgens act on a variety of organs ranging from the mammary gland to the uterus, oviducts, and vagina. Not only are androgens essential for reproductive development in women, but they are also vital to the production of estrogens, and for the maintenance of sexual libido. Androgens have a three-fold action on female sexual function. They (1) increase libido by providing the fuel for a woman’s psychosexual stimulation, (2) increase sensitivity and blood flow to the external genitalia, and (3) increase the intensity of sexual gratification.

Although androgens have been extensively studied, their role in sexual functioning is poorly understood. Recent investigations have implicated androgens as modulators of sexual desire, arousal, and orgasm in women. Thus, the lack of androgens have been implicated in mediating the symptoms of female sexual dysfunction. At the onset of menopause there is a dramatic decrease in circulating estrogen levels. However, recent studies show that androgen levels drop before menopause, following an age-related decline from peak levels. This unexplained, gradual decrease in androgens results in symptoms such as impaired sexual function, decreased well being, fatigue, and loss of bone mass, low libido and lack of desire for intimacy. Many women have been conditioned to believe that these symptoms are the result of aging, however these symptoms of female sexual dysfunction seem to have a physiologic basis: low androgen levels. Until recently, symptoms of androgen insufficiency were treated with psychoactive drugs and other therapeutic agents. Recent studies show that these symptoms can be quickly identified and treated with androgen supplementation.

Androgen therapy (formerly called androgen replacement therapy or androgen supplementation) is a simple, inexpensive treatment for relieving both the physical and psychological symptoms of androgen insufficiency. However, despite the enormous prevalence of female sexual dysfunction in the United States, no product has yet been approved by the Food and Drug Administration for the treatment of female sexual dysfunction. A woman can choose to live with sexual dysfunction and low androgen levels without treatment.

Patients being treated for androgen insufficiency at the Center for Sexual Medicine must have blood tests routinely to ensure their hormone values are within normal limits. Blood tests should be taken every 3 months until the values normalize, at which time they should be taken every 6 months. If you have any questions regarding your treatment with androgen therapy, either now or at any time in the future, please feel free to ask them. If you are concerned about physical changes which might occur after you start androgen supplementation, please contact your physician here at the Center for Sexual Medicine at 617 638-8576.

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