Korean J Androl. 2012 Apr;30(1):13-22. Korean.
Published online Apr 30, 2012.
Copyright © Korean Society for Sexual Medicine and Andrology
Original Article

Hormone Replacement Therapy in Female Sexual Dysfunction

Hana Yoon
    • Department of Urology, School of Medicine, Ewha Womans University, Seoul, Korea.
Received April 06, 2012; Accepted April 25, 2012.

Abstract

Female sexual function is highly complex and deeply influenced by hormonal and non-hormonal factors. As sexual dysfunction becomes a common and important problem for women of all ages with related quality of life issues, we need to understand more about the effect of sex steroid hormones in female sexual function. However, there are limited data about the correlation between the value of sex steroid hormones- testosterone, in particular-and female sexual function. In a certain type of female sexual dysfunction (FSD), hypoactive sexual desire disorder, for example, there is evidence that treatment with androgens or with estrogens is effective. To widen the therapeutic options of hormone replacement therapy in FSD, further research is needed as to the benefits and risks of hormonal treatments in both pre- and post-menopausal women. Although important unanswered questions still exist in hormonal treatment of FSD, new therapeutic strategies are being studied and many ongoing clinical trials are expecting favorable results leading to more successful treatment of FSD.

Keywords
Testosterone; Estrogens; Sexual function

Figures

Fig. 1
Schematic diagram of sex steroidogenesis from cholesterol.

Tables

Table 1
Testosterone currently available in Korea*

References

    1. Woodis CB, McLendon AN, Muzyk AJ. Testosterone supplementation for hypoactive sexual desire disorder in women. Pharmacotherapy 2012;32:38–53.
    1. White WB, Grady D, Giudice LC, Berry SM, Zborowski J, Snabes MC. A cardiovascular safety study of LibiGel (testosterone gel) in postmenopausal women with elevated cardiovascular risk and hypoactive sexual desire disorder. Am Heart J 2012;163:27–32.
    1. Derogatis LR, Komer L, Katz M, Moreau M, Kimura T, Garcia M Jr, et al. on behalf of the VIOLET trial investigators. Treatment of hypoactive sexual desire disorder in premenopausal women: efficacy of flibanserin in the VIOLET study. J Sex Med 2012;9:1074–1085.
    1. Thorp J, Simon J, Dattani D, Taylor L, Kimura T, Garcia M Jr, et al. DAISY trial investigators. Treatment of hypoactive sexual desire disorder in premenopausal women: efficacy of flibanserin in the DAISY study. J Sex Med 2012;9:793–804.
    1. Trocóniz IF, Boland K, Staab A. Population pharmacokinetic/pharmacodynamic model for the sedative effects of flibanserin in healthy volunteers. Pharm Res. 2012
      [Epub ahead of print].
    1. van der Made F, Bloemers J, Yassem WE, Kleiverda G, Everaerd W, van Ham D, et al. The influence of testosterone combined with a PDE5-inhibitor on cognitive, affective, and physiological sexual functioning in women suffering from sexual dysfunction. J Sex Med 2009;6:777–790.
    1. A double-blind, randomized, placebo-controlled, dose-finding study to investigate the safety and efficacy of Lybrido in the domestic setting in healthy female subjects with hypoactive sexual desire disorder and low sensitivity for sexual cues [Internet].
    1. Gruber CJ, Tschugguel W, Schneeberger C, Huber JC. Production and actions of estrogens. N Engl J Med 2002;346:340–352.
    1. Nathan SG. When do we say a woman's sexuality is dysfunctional?. In: Levine SB, Risen CB, Althof SE, editors. Handbook of clinical sexuality for mental health professionals. New York: Brunner-Routledge; 2003. pp. 95-110.
    1. Chivers ML, Seto MC, Lalumière ML, Laan E, Grimbos T. Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis. Arch Sex Behav 2010;39:5–56.
    1. van Thiel SW, Romijn JA, Pereira AM, Biermasz NR, Roelfsema F, van Hemert A, et al. Effects of dehydroepiandrostenedione, superimposed on growth hormone substitution, on quality of life and insulin-like growth factor I in patients with secondary adrenal insufficiency: a randomized, placebo-controlled, cross-over trial. J Clin Endocrinol Metab 2005;90:3295–3303.
    1. Wisniewski AB, Migeon CJ, Meyer-Bahlburg HF, Gearhart JP, Berkovitz GD, Brown TR, et al. Complete androgen insensitivity syndrome: long-term medical, surgical, and psychosexual outcome. J Clin Endocrinol Metab 2000;85:2664–2669.
    1. Minto CL, Liao KL, Conway GS, Creighton SM. Sexual function in women with complete androgen insensitivity syndrome. Fertil Steril 2003;80:157–164.
    1. Carmina E, Rosato F, Jannì A, Rizzo M, Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab 2006;91:2–6.
    1. Himelein MJ, Thatcher SS. Polycystic ovary syndrome and mental health: A review. Obstet Gynecol Surv 2006;61:723–732.
    1. Janssen OE, Hahn S, Tan S, Benson S, Elsenbruch S. Mood and sexual function in polycystic ovary syndrome. Semin Reprod Med 2008;26:45–52.
    1. Wierman ME, Nappi RE, Avis N, Davis SR, Labrie F, Rosner W, et al. Endocrine aspects of women's sexual function. J Sex Med 2010;7:561–585.
    1. Battaglia C, Nappi RE, Mancini F, Cianciosi A, Persico N, Busacchi P, et al. PCOS, sexuality, and clitoral vascularisation: a pilot study. J Sex Med 2008;5:2886–2894.
    1. Conaglen HM, Conaglen JV. Sexual desire in women presenting for antiandrogen therapy. J Sex Marital Ther 2003;29:255–267.
    1. Al-Azzawi F, Palacios S. Hormonal changes during menopause. Maturitas 2009;63:135–137.
    1. Park K, Kim MK, Kim KW, Ahn KY, Lee SE, Ryu SB. Effect of delayed estrogen replacement on clitoral corpus cavernosal blood flow and histologic composition in rabbit. Korean J Urol 2004;45:268–273.
    1. Freeman EW, Sammel MD, Lin H, Gracia CR, Pien GW, Nelson DB, et al. Symptoms associated with menopausal transition and reproductive hormones in midlife women. Obstet Gynecol 2007;110:230–240.
    1. Dennerstein L, Dudley E, Burger H. Are changes in sexual functioning during midlife due to aging or menopause? Fertil Steril 2001;76:456–460.
    1. Mishra G, Kuh D. Sexual functioning throughout menopause: the perceptions of women in a British cohort. Menopause 2006;13:880–890.
    1. Gallicchio L, Schilling C, Tomic D, Miller SR, Zacur H, Flaws JA. Correlates of sexual functioning among mid-life women. Climacteric 2007;10:132–142.
    1. Avis NE, Stellato R, Crawford S, Johannes C, Longcope C. Is there an association between menopause status and sexual functioning? Menopause 2000;7:297–309.
    1. Santoro N, Torrens J, Crawford S, Allsworth JE, Finkelstein JS, Gold EB, et al. Correlates of circulating androgens in mid-life women: the study of women's health across the nation. J Clin Endocrinol Metab 2005;90:4836–4845.
    1. Kim JY, Cho JC, Lim SH, Jeong SM, Rhyu CH, Kim JD. Assessment about quality of life in menopausal women with hormone replacement therapy. Korean J Obstet Gynecol 1998;41:2429–2435.
    1. Burger HG, Dudley EC, Cui J, Dennerstein L, Hopper JL. A prospective longitudinal study of serum testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin levels through the menopause transition. J Clin Endocrinol Metab 2000;85:2832–2838.
    1. Jun JH, Yoon H. Effect of menopause on the expression of androgen receptors in human vagina. Korean J Androl 2004;22:24–30.
    1. Nathorst-Böös J, von Schoultz B. Psychological reactions and sexual life after hysterectomy with and without oophorectomy. Gynecol Obstet Invest 1992;34:97–101.
    1. Shifren JL, Avis NE. Surgical menopause: effects on psychological well-being and sexuality. Menopause 2007;14:586–591.
    1. Farquhar CM, Harvey SA, Yu Y, Sadler L, Stewart AW. A prospective study of 3 years of outcomes after hysterectomy with and without oophorectomy. Am J Obstet Gynecol 2006;194:711–717.
    1. Teplin V, Vittinghoff E, Lin F, Learman LA, Richter HE, Kuppermann M. Oophorectomy in premenopausal women: health-related quality of life and sexual functioning. Obstet Gynecol 2007;109:347–354.
    1. Adashi EY. The climacteric ovary as a functional gonadotropin-driven androgen-producing gland. Fertil Steril 1994;62:20–27.
    1. Leiblum SR, Koochaki PE, Rodenberg CA, Barton IP, Rosen RC. Hypoactive sexual desire disorder in postmenopausal women: US results from the Women's International Study of Health and Sexuality (WISHeS). Menopause 2006;13:46–56.
    1. Stuckey BG. Female sexual function and dysfunction in the reproductive years: the influence of endogenous and exogenous sex hormones. J Sex Med 2008;5:2282–2290.
    1. Woodis CB. Hormone therapy for the management of menopausal symptoms: pharmacotherapy update. J Pharm Pract 2010;23:540–547.
    1. Taylor HS, Manson JE. Update in hormone therapy use in menopause. J Clin Endocrinol Metab 2011;96:255–264.
    1. Ewies AA, Alfhaily F. Topical vaginal estrogen therapy in managing postmenopausal urinary symptoms: a reality or a gimmick? Climacteric 2010;13:405–418.
    1. Laan E, van Lunsen RH, Everaerd W. The effects of tibolone on vaginal blood flow, sexual desire and arousability in postmenopausal women. Climacteric 2001;4:28–41.
    1. Rymer J, Chapman MG, Fogelman I, Wilson PO. A study of the effect of tibolone on the vagina in postmenopausal women. Maturitas 1994;18:127–133.
    1. Cummings SR, Ettinger B, Delmas PD, Kenemans P, Stathopoulos V, Verweij P, et al. LIFT Trial Investigators. The effects of tibolone in older postmenopausal women. N Engl J Med 2008;359:697–708.
    1. Dören M, Rübig A, Coelingh Bennink HJ, Holzgreve W. Differential effects on the androgen status of postmenopausal women treated with tibolone and continuous combined estradiol and norethindrone acetate replacement therapy. Fertil Steril 2001;75:554–559.
    1. Nappi RE, Ferdeghini F, Sampaolo P, Vaccaro P, De Leonardis C, Albani F, et al. Clitoral circulation in postmenopausal women with sexual dysfunction: a pilot randomized study with hormone therapy. Maturitas 2006;55:288–295.
    1. Davis S, Papalia MA, Norman RJ, O'Neill S, Redelman M, Williamson M, et al. Safety and efficacy of a testosterone metered-dose transdermal spray for treating decreased sexual satisfaction in premenopausal women: a randomized trial. Ann Intern Med 2008;148:569–577.
    1. Johnson CE, Berman JR. The role of androgens in hormone replacement therapy. Expert Opin Pharmacother 2005;6:1815–1831.
    1. Buster JE, Kingsberg SA, Aguirre O, Brown C, Breaux JG, Buch A, et al. Testosterone patch for low sexual desire in surgically menopausal women: a randomized trial. Obstet Gynecol 2005;105:944–952.
    1. Braunstein GD, Sundwall DA, Katz M, Shifren JL, Buster JE, Simon JA, et al. Safety and efficacy of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial. Arch Intern Med 2005;165:1582–1589.
    1. Simon J, Braunstein G, Nachtigall L, Utian W, Katz M, Miller S, et al. Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder. J Clin Endocrinol Metab 2005;90:5226–5233.
    1. Davis SR, Braunstein GD. Efficacy and safety of testosterone in the management of hypoactive sexual desire disorder in postmenopausal women. J Sex Med 2012;9:1134–1148.
    1. Janssen I, Powell LH, Crawford S, Lasley B, Sutton-Tyrrell K. Menopause and the metabolic syndrome: the study of women's health across the nation. Arch Intern Med 2008;168:1568–1575.
    1. Page-Wilson G, Goulart AC, Rexrode KM. Interrelation between sex hormones and plasma sex hormone-binding globulin and hemoglobin A1c in healthy postmenopausal women. Metab Syndr Relat Disord 2009;7:249–254.
    1. Bell RJ, Donath S, Davison SL, Davis SR. Endogenous androgen levels and well-being: differences between premenopausal and postmenopausal women. Menopause 2006;13:65–71.
    1. North American Menopause Society. The role of testosterone therapy in postmenopausal women: position statement of The North American Menopause Society. Menopause 2005;12:496–511.
    1. Traish AM, Kang HP, Saad F, Guay AT. Dehydroepiandrosterone (DHEA)--a precursor steroid or an active hormone in human physiology. J Sex Med 2011;8:2960–2982.
    1. Baulieu EE, Thomas G, Legrain S, Lahlou N, Roger M, Debuire B, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge study to a sociobiomedical issue. Proc Natl Acad Sci USA 2000;97:4279–4284.
    1. Genazzani AR, Stomati M, Valentino V, Pluchino N, Pot E, Casarosa E, et al. Effect of 1-year, low-dose DHEA therapy on climacteric symptoms and female sexuality. Climacteric 2011;14:661–668.

Metrics
Share
Figures

1 / 1

Tables

1 / 1

PERMALINK