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 testosterone levels. While estrogen is often discussed in relation to female sexual function, testosterone plays a critical role in sexual desire and arousal across genders [@1@]. 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, enhancing blood flow and sensation, while also acting centrally in the brain to influence sexual desire. The relationship between testosterone and female sexual function is dose-dependent, with both very low and very high levels potentially causing dysfunction. Other hormones like estrogen and progesterone contribute to sexual health by maintaining vaginal tissue integrity and lubrication, but testosterone specifically impacts libido and arousal mechanisms. For women experiencing these symptoms, testosterone therapy may be considered, though it remains controversial and is often prescribed off-label with careful monitoring for side effects.

Some key points to consider:

• The decline of estrogen production is associated with reduction of bone mineral density [@1@], but this does not directly impact libido, arousal, orgasm, and genital sensation.
• Testosterone therapy may be considered for women experiencing decreased libido, arousal, orgasm, and genital sensation, but careful monitoring for side effects is necessary.
• The relationship between testosterone and female sexual function is complex and dose-dependent, with both very low and very high levels potentially causing dysfunction.
• Other hormones like estrogen and progesterone contribute to sexual health, but testosterone specifically impacts libido and arousal mechanisms.

It's worth noting that the provided evidence [@1@, @2@] primarily discusses the effects of hormone replacement therapy on osteoporosis and other chronic conditions, rather than directly addressing the relationship between serum hormone levels and female sexual function. However, the critical role of testosterone in female sexual health is well-established, and testosterone is the most directly associated hormone with decreased libido, arousal, orgasm, and genital sensation in aging women.

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 1
  • Estrogen also plays a role in maintaining vaginal mucosal epithelium, sensory thresholds, and genital blood flow 2
• Other factors that may contribute to female sexual dysfunction include:
  • Vascular insufficiency, such as atherosclerosis 2
  • Neurologic diseases, such as diabetic neuropathy 2, 3
  • Changes in hormonal levels, including decreased androgen production during menopause 1
  • Medications with sexual side effects 2, 3
  • Psychological factors, such as depression 3
• The use of testosterone replacement therapy (TRT) has been shown to be effective in treating hypoactive sexual desire disorder (HSDD) in postmenopausal women 1