What hormone is directly associated with decreased libido, arousal, orgasm, and genital sensation in aging women: estrogen, progesterone, serotonin, testosterone, or sex hormone-binding globulin (SHBG)?

From the Guidelines

The answer is D. Testosterone, as decreased libido, arousal, orgasm, and genital sensation in aging women is directly associated with declining serum levels of testosterone. While estrogen is often discussed in relation to female sexual function, testosterone plays a critical role in sexual desire and arousal across genders. In women, testosterone is produced by the ovaries and adrenal glands, and levels naturally decline with age, particularly after menopause. This decline correlates with reduced sexual interest and response. Physiologically, testosterone affects genital tissues, enhances neural pathways involved in sexual arousal, and influences dopamine release, which is important for sexual motivation. The relationship between testosterone and female sexual function is dose-dependent, with both very low and very high levels potentially causing problems. While other hormones like estrogen affect vaginal lubrication and tissue health, testosterone specifically impacts libido and arousal mechanisms. This is why testosterone therapy is sometimes considered for postmenopausal women with sexual dysfunction when other causes have been ruled out.

Key Points

• Testosterone levels decline with age in women, particularly after menopause 1.
• This decline is associated with reduced sexual interest and response.
• Testosterone affects genital tissues, neural pathways involved in sexual arousal, and dopamine release.
• The relationship between testosterone and female sexual function is dose-dependent.
• Testosterone therapy may be considered for postmenopausal women with sexual dysfunction.

Relevant Evidence

The provided evidence focuses on the effects of hormone replacement therapy on postmenopausal women, including the prevention of chronic conditions such as osteoporosis and fractures 1. However, it does not directly address the relationship between serum hormone levels and female sexual function. Despite this, the critical role of testosterone in female sexual health is well-established, making it the most relevant hormone in this context.

Clinical Implications

In clinical practice, testosterone levels should be considered when evaluating postmenopausal women with decreased libido, arousal, orgasm, and genital sensation. While estrogen therapy may be beneficial for vaginal lubrication and tissue health, testosterone therapy may be necessary to address issues related to sexual desire and arousal. It is essential to weigh the benefits and risks of hormone replacement therapy and to individualize treatment based on each patient's needs and medical history.

From the Research

Decreased Libido, Arousal, Orgasm, and Genital Sensation in Aging Women

• The decrease in libido, arousal, orgasm, and genital sensation in aging women is directly associated with serum levels of:
  • Androgens, specifically testosterone 2
  • Estrogen also plays a significant role in maintaining vaginal mucosal epithelium, sensory thresholds, and genital blood flow 3
• Other factors that may contribute to female sexual dysfunction include:
  • Vascular insufficiency, such as atherosclerosis 3
  • Neurologic diseases, such as diabetic neuropathy 3, 4
  • Changes in hormonal levels, including decreased androgen production during menopause 2
  • Medications with sexual side effects 3
  • Psychological factors, such as depression 4
• The use of Testosterone Replacement Therapy (TRT) has been shown to be an effective treatment option for postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD) 2
• Estrogen replacement therapy has also been used to treat female sexual dysfunction, with benefits including decreased pain and burning during intercourse 3