Androgens are naturally synthesized by the ovary, the adrenal gland and from androgen precursors in peripheral organs. Androgen synthesis occurs in only one direction in the body, and while all these androgen and androgen precursor hormones are likely important for tissue structure and function, only 4 of the 7 may be clinically measured: dehydroepiandrosterone (DHEA), androstenedione, testosterone, and dihydrotestosterone (DHT).
Dehydroepiandrosterone, the first or precursor androgen, is converted by an enzyme into androstenedione, which is then converted by a different enzyme into testosterone, which is then converted by a different enzyme to dihydrotestosterone. Women with low dehydroepiandrosterone blood levels can raise that level and the rest of the androgen levels with dehydroepiandrosterone treatment. In contrast, women with low testosterone blood levels raise only the testosterone and dihydrotestosterone levels with testosterone therapy, as you can’t convert “backwards” into the early part of the synthetic cascade. It should be noted that both dehydroepiandrosterone and testosterone use can raise estradiol values in women. This action is due to testosterone converting to estradiol by the enzyme aromatase.
Androgens and androgen precursors have a profound effect on many physiological functions in women including: stimulation of sexual desire, interest, thoughts, and fantasies; regulation of genital (vaginal and clitoral) blood flow; amount and quality of vaginal lubrication; structural and functional integrity of the clitoris, prepuce, vaginal muscularis (smooth muscle layer), G-spot, and minor vestibular glands; stimulation of bone growth; increase in muscle mass; maintenance of energy and well-being; maintenance of lean body composition; control of oil gland activity in skin; and regulation of body hair growth. Although testosterone appears to be a vital component of women’s sexual health and is an important factor in women’s overall health, women with low testosterone can still have a satisfactory sex life.
If you fit the clinical symptoms of androgen insufficiency, have a blood test consistent with low “unbound” testosterone values, and have personal distress, you may wish to consider treatment for low androgens. The two most widely used androgens for treatment of sexual health problems are dehydroepiandrosterone and testosterone.
Dehydroepiandrosterone is considered as “off-label” treatment as it is not approved specifically for use in women with sexual health concerns. The bioidentical form of DHEA is recommended, but many brands actually have limited amounts of active medication. Blood tests measuring dehydroepiandrosterone-sulfate, usually at 6 week to 3-month intervals, should be repeated until the appropriate blood level is stable.
Testostoerone is the most common “off-label” androgen prescribed for treatment of sexual dysfunction in women. There are FDA-approved versions of bioidentical testosterone indicated for men for the treatment of hypogonadism. The individual dose for women with sexual health problems is usually 10% of a man’s daily dose, but blood tests of “unbound” testosterone, usually at 3-month intervals, must be repeated to establish the appropriate dose for each woman with sexual health concerns. Reports documenting facilitation of the sexual response in women by testosterone were published as early as 1938.
The long-term safety of testosterone use in women for sexual health concerns has not yet been established. Women considering treatment with testosterone for their sexual health concerns need to be aware of the following possible healthcare risks. Body hair growth and acne are experience by 3% to 8% of women users of testosterone, but these side effects are usually mild and dependent upon dose and duration of testosterone treatment. Reports show no increase in breast cancer risk among women using bioidentical testosterone for management of sexual health problems.