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

Testosterone is Most Directly Associated with Decreased Sexual Function in Aging Women

Decreased libido, arousal, orgasm, and genital sensation in aging women is directly associated with diminished serum levels of testosterone. 1

Hormonal Changes and Sexual Function in Aging Women

Role of Testosterone

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

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

• The American Urological Association recommends confirming hormone deficiency through laboratory testing when evaluating sexual dysfunction in aging women 1

• Topical vaginal testosterone has been shown to improve sexual desire, lubrication, satisfaction, and reduce pain in aging women with low testosterone levels 1

• Oral DHEA (which converts to testosterone) has demonstrated effectiveness in restoring sexual desire in women with low testosterone levels 1

Other Hormones and Their Effects

Estrogen

• While estrogen deficiency causes vaginal atrophy and reduced lubrication 2, it primarily affects the physical aspects of sexual function rather than desire and arousal
• Estrogen therapy effectively treats vaginal dryness, itching, discomfort, and painful intercourse in postmenopausal women 3
• Vaginal estrogen is effective for treating atrophic vaginitis but does not directly address libido issues 3

Progesterone

• There is limited evidence supporting progesterone's direct role in female sexual function
• Guidelines do not specifically recommend progesterone for treating sexual dysfunction in aging women 3, 1

Sex Hormone Binding Globulin (SHBG)

• SHBG levels can increase with age, further reducing free testosterone availability 1
• However, SHBG itself is not the primary cause but rather a contributing factor by binding to testosterone and reducing its bioavailability

Treatment Approaches for Sexual Dysfunction in Aging Women

Hormone-Based Treatments

• For decreased libido and arousal:

  • Testosterone therapy (topical or systemic) 1
  • DHEA supplementation (oral 50-100mg daily) 1

• For vaginal symptoms and dyspareunia:

  • Vaginal estrogen (pills, rings, or creams) 3
  • Vaginal DHEA (prasterone) 3
  • Ospemifene (SERM) for dyspareunia in women without history of hormone-sensitive cancers 3

Non-Hormonal Approaches

• Vaginal moisturizers and lubricants for dryness 3
• Pelvic floor muscle training for sexual pain, arousal, lubrication, and orgasm issues 3
• Vaginal dilators for pain during sexual activity 3
• Flibanserin for acquired, generalized hypoactive sexual desire disorder in premenopausal women 3

Clinical Considerations and Potential Pitfalls

Important Cautions

• Hormone therapy should not be used if contraindicated by primary oncologic diagnosis, such as hormone-sensitive cancers 1
• Certain medications can contribute to sexual dysfunction, including:
  • Antidepressants (particularly SSRIs)
  • Hormone therapy (aromatase inhibitors)
  • Narcotics
  • Beta-blockers
  • Spironolactone 1

Assessment Approach

• Use validated assessment tools such as the Female Sexual Function Index (FSFI) to evaluate sexual dysfunction 1
• Screen for all domains of sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain 1
• Regular monitoring for improvement in sexual function is essential when initiating therapy 1

In summary, while multiple hormones affect female sexual function, testosterone deficiency is most directly associated with the constellation of decreased libido, arousal, orgasm, and genital sensation in aging women. Other hormones like estrogen primarily address specific aspects such as vaginal health and lubrication, but do not comprehensively address all components of sexual function.