Androgens in Health and Disease.pdf - E Library

282 Bancroft
in response to the film in the T condition. However, this effect was not reflected in
subjective ratings of excitement or “lust.” Nor did the two treatments differ in terms of
daily ratings of sexuality or mood. This experiment therefore demonstrated an effect of
increasing T on physiological response to erotic stimulation, which was not apparent in
any subjective or mood measures.
Summary of Evidence in the Female
There are enough pointers in the literature reviewed to indicate that T has a role in the
sexuality of women. However, the evidence is inconsistent and confusing, and, in a number
of cases, contradictory. There are a number of possible explanations for this state of affairs.
1. Women may vary in the extent to which their sexuality is influenced by T. There is much
indirect evidence to support this: the wide variation in age of onset of masturbation in
women, suggestive of a variable impact of hormonal influences (46); the negative sexual
effect that antiandrogens have in a proportion of women (129); the possibility that oral
contraceptives reduce sexual interest by lowering free T but only in a proportion of
women (124); the finding that sexual interest is lowered in many but not all women after
oophorectomy (50% in ref. 103). Sherwin (131) commented that “considerable intersubject
variability in both plasma T levels and aspects of sexual behavior in oophorectomized
women in response to a standard dose of E-A preparation has been observed in
our studies.” Yet, this possibility has received virtually no attention in the extensive
literature on hormone replacement. If the responsiveness of women to the sexual effects
of T does vary markedly across women, then we should expect to find considerable
inconsistency across studies if this source of variability is not controlled.
2. Uncertainty about the extent to which observed behavioral effects of exogenous T are
direct androgen effects or indirect effects resulting from increased availability of bioactive
estrogen, resulting both from the conversion of T to E 2, and reduced binding of E 2 in the
presence of increased T.
3. The sexuality of women is powerfully influenced by mood, energy, and well-being and
these aspects are affected by a wide variety of factors. The possible relationship between
T and mood will be considered in the final section. Although these aspects of affect have
been assessed as well as sexuality in many of the studies considered, very few have
directly considered the extent to which affect influences sexuality.
4. In addition to affect, the sexuality of women is powerfully influenced by other psychological
mechanisms. This is implied by the finding in several studies of younger women,
that the relationship between T and sexuality was most apparent in women whose sexuality
was unproblematic (e.g., refs. 118, 128, and 130). Thus, whereas T may play a role
in the sexuality of many women, its effects can easily be obscured by the coexistence of
other psychological or affective factors.
COMPARISON OF ANDROGEN EFFECTS IN MEN AND WOMEN
What might we learn by directly comparing the effects of androgens in the two sexes?
1. The evidence is more consistent for the male than for the female, even though there are
many more opportunities to study hormone–behavior relationships in women, and there
is a much more substantial body of data. Apart from methodological considerations,
which are more complex in women than men, potentially the most important factor
accounting for this gender difference is a greater variability of behavioral responsiveness
to androgens among women suggested earlier. There obviously is variability among men,
but it appears to be of a much smaller magnitude.