Clinical Question: Is a low level of serum testosterone associated with low sexual desire in women?

Setting: Population-based

Study Design: Cross-sectional

Synopsis: In this study, investigators randomly sampled community-dwelling women who were 18 to 75 years of age and living in Victoria, Australia. Exclusion criteria included current use of psychiatric medication, abnormal thyroid function, documented polycystic ovary syndrome, and current use of oral contraception in women younger than 45 years. Sexual desire and function were measured using a prevalidated questionnaire.

The investigators found no significant association between a low level of total testosterone, free testosterone, or androstenedione and a low score for sexual desire and function. Women with low scores for sexual desire and function were more likely to have a serum dehydroepiandrosterone sulfate (DHEA) level below the 10th percentile for their age group, but the majority of women with a low level of DHEA did not have low sexual function. Because only 1,021 consenting women from an initial group of 15,621 met all inclusion criteria, these results may not be generalizable to all women.

Bottom Line: Low levels of total and free testosterone are not associated with low sexual desire and function in women. A serum DHEA level below the age-adjusted 10th percentile is a better marker for low sexual desire and function, but the majority of women with a low level of DHEA do not have sexual dysfunction. There is no evidence to support the measurement of serum testosterone in women with low sexual desire or function. The practice of prescribing exogenous testosterone for women with low sexual desire or function requires further study and should not be routine. (Level of Evidence: 2c)