Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens

• Type of Material: Article
• Authors: Kim Wallen, Emory University; Maurand Cappelletti, Emory University
• Language: English
• Date: 2016-02-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.yhbeh.2015.11.003
• Title of Journal or Parent Work: Hormones and Behavior
• ISSN: 0018-506X
• Volume: 78
• Start Page: 178
• End Page: 193
• Grant/Funding Information: This work was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development 1R21HD078077-01, and by the National Science Foundation Graduate Training Fellowship.
• Keywords: estradiol; menopause; testosterone; hormone therapy; sexual desire
• Research Categories: Psychology, Behavioral

Abstract

Both estradiol and testosterone have been implicated as the steroid critical for modulating women’s sexual desire. By contrast, in all other female mammals only estradiol has been shown to be critical for female sexual motivation and behavior. Pharmaceutical companies have invested heavily in the development of androgen therapies for female sexual desire disorders, but today there are still no FDA approved androgen therapies for women. Nonetheless, testosterone is currently, and frequently, prescribed off-label for the treatment of low sexual desire in women, and the idea of testosterone as a cure-all for female sexual dysfunction remains popular. This paper places the ongoing debate concerning the hormonal modulation of women’s sexual desire within a historical context, and reviews controlled trials of estrogen and/or androgen therapies for low sexual desire in postmenopausal women. These studies demonstrate that estrogen-only therapies that produce periovulatory levels of circulating estradiol increase sexual desire in postmenopausal women. Testosterone at supraphysiological, but not at physiological, levels enhances the effectiveness of low-dose estrogen therapies at increasing women’s sexual desire; however, the mechanism by which supraphysiological testosterone increases women’s sexual desire in combination with an estrogen remains unknown. Because effective therapies require supraphysiological amounts of testosterone, it remains unclear whether endogenous testosterone contributes to the modulation of women’s sexual desire. The likelihood that an androgen-only clinical treatment will meaningfully increase women’s sexual desire is minimal, and the focus of pharmaceutical companies on the development of androgen therapies for the treatment of female sexual desire disorders is likely misplaced.