What is decreased libido, arousal, orgasm, and genital sensation in aging women directly associated with?

Decreased Libido, Arousal, Orgasm, and Genital Sensation in Aging Women is Associated with Diminished Testosterone Levels

Decreased libido, arousal, orgasm, and genital sensation in aging women is directly associated with diminished serum levels of testosterone. 1, 2 The decline in both total and free testosterone levels correlates positively with female sexual function index domains including desire, arousal, lubrication, and orgasm.

Hormonal Changes and Sexual Function in Aging Women

Testosterone's Role

• Testosterone plays a critical role in female sexual function, particularly affecting:

  • Sexual desire/libido
  • Arousal capacity
  • Genital sensation
  • Orgasmic function

• Women with low libido demonstrate significantly lower levels of:

  • Total testosterone
  • Free testosterone
  • DHEA-S (dehydroepiandrosterone sulfate)
  • These decreased androgen levels positively correlate with sexual function scores 2

Age-Related Hormonal Changes

• Sex hormone-binding globulin (SHBG) levels increase with age, further reducing free testosterone availability 1
• While estrogen decline causes vaginal atrophy and reduced lubrication, testosterone deficiency specifically impacts desire and arousal domains 1

Diagnostic Considerations

Laboratory Assessment

• Measurement of total and free testosterone levels is recommended when evaluating sexual dysfunction in aging women 1
• Androgen precursor hormones (DHEA-S and Androstenedione) should also be assessed 3
• The American Urological Association recommends confirming testosterone deficiency through laboratory testing 1

Clinical Assessment

• Use validated assessment tools such as:
  • Female Sexual Function Index (FSFI)
  • Brief Sexual Symptom Checklist for Women 1
• Evaluate all domains of sexual functioning: desire, arousal, lubrication, orgasm, satisfaction, and pain 1

Treatment Approaches

Testosterone Therapy

• Consider testosterone therapy when laboratory confirms deficiency 1
• Topical vaginal testosterone shows improvement in:
  • Sexual desire
  • Lubrication
  • Satisfaction
  • Reduced pain 1

DHEA Supplementation

• Oral DHEA (50-100 mg daily) has shown effectiveness in restoring sexual desire in women with low testosterone levels 3, 4
• DHEA supplementation can normalize androgen levels, including:
  • Total testosterone
  • Free testosterone
  • DHEA-S
  • Androstenedione 4

Monitoring and Follow-up

• Regular assessment of symptom improvement is essential
• The American College of Physicians recommends monitoring for improvement in sexual function within 12 months of initiating therapy 1
• Discontinue treatment if no improvement is observed after an adequate trial period

Important Considerations and Cautions

• Side effects of androgen therapy may include:

  • Increased facial hair (11%)
  • Weight gain (7%)
  • Acne (5%)
  • Temporary breast tenderness (1%)
  • Loss of head hair (1%)
  • Skin rash (1%) 4

• Contraindications:

  • Testosterone therapy should not be used if contraindicated by primary oncologic diagnosis (e.g., hormone-sensitive cancers) 5
  • Use caution with hormone therapy in breast cancer survivors 1

• Comprehensive approach:

  • Address other contributing factors like depression, anxiety, medications (SSRIs, beta-blockers), and medical comorbidities 1
  • Consider non-hormonal treatments for vaginal symptoms (moisturizers, lubricants) 1

While multiple hormonal changes occur with aging, the evidence clearly demonstrates that diminished testosterone levels specifically correlate with decreased libido, arousal, orgasm, and genital sensation in aging women.