The prevalence of sexual dysfunction in women approaches 43%, and age is an important correlate. The underlying etiology of sexual dysfunction in women is complex. Nevertheless, hormonal changes such as loss of estrogens and androgens contribute significantly to some of the sexual difficulties experienced by aging women.
In women, direct ovarian production accounts for half the circulating T, while the other half is produced through peripheral conversion from adrenal precursors. Both ovary and adrenal gland contribute equally to circulating androstenedione, while 90% of DHEA is produced by the adrenal gland. Oophorectomy in premenopausal women reduces T and androstenedione levels by 50%, while in menopause, T changes minimally and androstenedione decreases by 50%. Total T, free T, and androstenedione are lower in women with central hypoadrenalism and hypogonadism secondary to hypopituitarism than in subjects with hypoadrenalism or hypogonadism alone.
Female androgen deficiency (FAD) is diagnosed when there are clinical symptoms, decreased bioavailable T, and normal estrogen status. The potential causes of FAD include diseases of ovary, adrenal gland, or hypothalamic-pituitary unit, or drug-related or idiopathic causes.
Optimal treatment of Female Androgen Deficiency is being investigated. Interventional trials with DHEA have shown limited effects in select populations such as those with adrenal insufficiency. T replacement therapy has been utilized in few double blindness in elderly randomized trials. Improvements in sexual activity elderly desire, vasomotor symptoms, and mood have been documented. However, potential side effects such as acne, hirsutism, deepening of the voice, and possibly increased aging cardiovascular or breast cancer risk are of concern.
The exact interplay between the estrogens and androgens as to sexual activity is not known, and the correlation between specific serum hormone replacement therapy levels and sexual activity is not always consistent. Controlled trials of estrogen and/or T therapy in Female Androgen Deficiency have shown an improvement in sexual function among natural or surgically menopausal women. However, long-term safety of hormonal therapy, optimal types, doses, and routes of therapy are not currently established.
