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Chapter 14/Androgens and Sexual Function 279
on general well-being. In a placebo-controlled evaluation of DHEA administration to
women between 40 and 70 yr (114), there was significant improvement in their somewhat
crude measure of well-being, but no effect on “libido.” Arlt et al. (115) evaluated
DHEA replacement in women with adrenal insufficiency that was not age related and
that had hitherto been treated with corticosteroids only. The addition of DHEA, compared
to placebo, improved measures of depression, anxiety, general well-being, and
sexual interest and responsiveness, although the greatest improvements were in the
levels of depression and anxiety. These sexual effects could well have been secondary
to improvements in general well-being and energy. Interestingly, these improvements
were only clearly apparent after 4 mo of DHEA replacement.
Clinical Studies of Low Sexual Desire
Few studies have investigated T levels in women presenting specifically with problems
of low sexual desire, rather than a more general set of menopause-related complaints.
Stuart et al. (116) compared T levels in 11 women with the diagnosis of Inhibited
Sexual Desire and 11 women with normal sexual desire and found no differences. Similarly,
Schreiner-Engel et al. (117) compared 17 women, aged 27–39, who met DSM IV
criteria for severe, persistent, and generalized loss of sexual desire, with 13 healthy
sexually active women. They found no differences in T or other reproductive hormones.
Riley and Riley (118) compared 15 women complaining of lifelong absence of sexual
drive with a comparison group of 15 women. Testosterone was measured around
midcycle. In the control group, FAI and total T correlated with sexual interest, whereas
only total T correlated with coital frequency. In the patient group, the only significant
correlation was between total T and coital frequency. The FAI index was significantly
lower in the patient group, although neither total T nor SHBG differed, and none of the
androgen levels were outside the normal laboratory range. Although the authors comment
that this provides “further evidence that testosterone is involved in sexual drive,”
it is questionable to what extent T was determining the sexual drive. The differences in
T between groups was subtle, whereas the measures of sexual interest and activity were
markedly different.
Controlled studies of the treatment of sexual problems in women with testosterone
have also been few. Carney et al. (119) studied 32 couples whose main problem was
sexual unresponsiveness of the woman. Using a balanced factorial design, they compared
the effects of either T or diazepam, given to the woman, each combined with sex
therapy (on a weekly or monthly basis). The combination of T plus counseling was
significantly superior to diazepam plus counseling on frequency of sexual thoughts,
enjoyment of sex, and a number of other variables. Mathews et al. (120) attempted to
replicate this study using placebo instead of diazepam and found no superiority of
testosterone over placebo. To control for the possible confounding effect of the combined
sex therapy, Dow and Gallagher (121) randomly allocated 30 couples, with the
principal complaint of sexual unresponsiveness of the woman, to three treatment regimes,
testosterone plus sex therapy, placebo plus sex therapy, and testosterone alone. The two
combined therapy groups did not differ from each other, but both were superior to the
testosterone alone treatment. The most likely explanation of the first study by Carney et
al. (119) was that the apparent superiority of T was, in fact, the result of a negative impact
of the diazepam on the effectiveness of the sex therapy.