Profiles of testosterone and pre-androgens and sexual function in premenopausal women

Abstract

Background: There is inconsistent evidence as to the role of testosterone and pre-androgens in premenopausal female sexual function, and reported associations between blood concentrations of these hormones and female sexual function vary in strength.

Aim: To examine the patterns of testosterone and pre-androgen concentrations and variations in sexual function in premenopausal eumenorrheic women.

Methods: This was a secondary analysis of a sample of 588 premenopausal eumenorrheic women from the Grollo-Ruzzene Foundation Young Women's Health Study. Socio-demographics, health information, and questionnaire data were collected using online surveys. Eligible women were invited to provide a blood sample. We ran latent profile analysis (LPA) and subsequent analyses in R using RStudio.

Outcomes: Indicator variables in the LPA included sexual arousal and desire domains of the Profile of Female Sexual Function and testosterone, dehydroepiandrosterone (DHEA), and androstenedione, measured by liquid chromatography-tandem mass spectrometry.

Results: Analyses resulted in a pattern of 3 latent classes. Classes reporting relatively lower and higher sexual arousal (LPA-derived means and 95% CIs: -0.79 [-1.24; -0.34] and 0.62 [0.51; 0.72]) did not differ significantly in sex steroid concentrations (testosterone: -0.21 [-0.38; -0.03] and -0.33 [-0.47; -0.20]; DHEA: -0.47 [-0.57; -0.37] and -0.26 [-0.39; -0.13]; androstenedione: -0.36 [-0.50; -0.22] and -0.39 [-0.49; -0.29]), while the class reporting relatively medium arousal (-0.11 [-0.31; 0.08]) showed the highest testosterone, DHEA, and androstenedione concentrations (testosterone: 0.8 [0.60; 1.01]; DHEA: 0.99 [0.76; 1.23]; androstenedione: 1.08 [0.88; 1.29]). There were no significant differences in sexual desire between classes (-0.08 [-0.23; 0.06]; 0.00 [-0.13; 0.14]; 0.10 [-0.09; 0.30]) differing significantly in sex steroid concentrations (-0.69 [-0.80; -0.58], -0.04 [-0.15; 0.07], 0.94 [0.71; 1.16] for testosterone) nor associations between the sex steroid concentrations and degrees of sexual desire.

Clinical implications: These findings cast further doubt on the utility of measuring sex steroids for diagnosing female sexual dysfunction in premenopausal eumenorrheic women, even when considered in combination.

Strengths and limitations: We analyzed a large community sample and controlled for potentially biasing factors. We analyzed sex steroid concentrations determined with gold-standard methodology. Excluding women with early menopause and menstrual dysfunction might have resulted in finding 3, rather than more, latent classes.

Conclusion: Testosterone and pre-androgen profiles do not clearly identify premenopausal eumenorrheic women with low sexual arousal and desire.

Keywords: DHEA; cross-sectional studies; female; premenopause; sexual function; testosterone.