Laboratory Testing for Women with Decreased Sex Drive
Routine hormonal testing is generally not recommended for women reporting decreased sex drive, as obtaining testosterone levels in women in nonresearch settings is not advised. 1
Primary Evaluation Approach
The evaluation of decreased libido in women should focus on clinical assessment rather than laboratory testing:
- Screening tools should be the first step, using validated instruments like the Brief Sexual Symptom Checklist for Women to assess the nature and severity of sexual dysfunction 1
- A thorough clinical history is essential, including screening for psychosocial problems (anxiety, depression, relationship issues, drug or alcohol use) that commonly contribute to sexual dysfunction 1
- Medication review is critical, particularly identifying hormone therapy, narcotics, and serotonin reuptake inhibitors that can decrease libido 1
When Laboratory Testing May Be Indicated
Laboratory work should be targeted based on specific clinical findings rather than routinely ordered:
Thyroid Function Testing
- TSH testing should be considered in perimenopausal women with nonspecific symptoms consistent with hypothyroidism 2
- TSH has high sensitivity (98%) and specificity (92%) for detecting thyroid disease 2
Hormone Testing for Specific Populations
- FSH, LH, and estradiol levels should be assessed in women with irregular menses, primary or secondary amenorrhea, or clinical signs of estrogen deficiency 2
- Testing should ideally occur between days 3-6 of the menstrual cycle 2
- Cancer survivors who received gonadotoxic therapy should have hormone testing to assess for premature ovarian failure 2
Androgen Testing (Limited Utility)
- Laboratory evaluation for androgen excess is recommended only when women have acne and additional signs of androgen excess or hirsutism with menstrual irregularities 2
- A typical screening panel would include free and total testosterone, DHEA-S, androstenedione, LH, and FSH 2
Assessment of Contributing Medical Conditions
Rather than routine lab work, evaluate for conditions associated with sexual dysfunction:
- Traditional risk factors including cardiovascular disease, diabetes, obesity, smoking, and alcohol abuse should be assessed clinically 1
- Physical and gynecologic examination should be performed to identify vaginal atrophy, anatomic changes, or points of tenderness 1
Key Clinical Pitfall
The most important caveat is that testosterone testing in women is explicitly not recommended in nonresearch settings 1, despite its common use in men with similar complaints. This represents a fundamental difference in the approach to male versus female sexual dysfunction. The guideline evidence is clear that the clinical utility of testosterone measurement in women with low libido has not been established, and treatment decisions should not be based on these levels.