Associations between testosterone and pre-androgens and sexual function; findings from the Australian Women's Midlife...

To determine the associations between the sex steroids and sexual function and difficulties in a national, community-based sample of women aged 40 to 69 years according to menopausal status.

This was a prespecified substudy of the cross-sectional Australian Women's Midlife Years Study.

Participants not pregnant, breastfeeding, on medications affecting sex hormone concentrations, or living over 100 km from blood collection centers were invited to provide a blood sample. Participants with thyroid dysfunction, hyperprolactinemia, pregnancy, bilateral oophorectomy, indiscernible menopause stage, missing samples, moderate-to-severe depressive symptoms, or psychotropic medication use were excluded from the analyses.

Sex hormones measured by liquid chromatography and tandem mass spectrometry.

The Profile of Female Sexual Function questionnaire completed between 27th October 2023 and 19th March 2024.

The analysis included 136 premenopausal and 595 perimenopausal and postmenopausal (peri-postmenopausal) participants, with median ages (range) of 45 (40-57) years and 61 (40-69) years, respectively. After adjustment for age, body mass index, residential location, ancestry, education, relationship status, smoking, alcohol, LGBTQIA+, moderate-to-severe vaginal dryness, and ever sexual abuse, no association was found between any hormone and sexual desire, or desire difficulty. Testosterone and androstenedione were nonlinearly associated with orgasm in premenopausal and peri-postmenopausal, respectively, and androstenedione with arousal in both groups. Peri-postmenopausal women with orgasm difficulty had lower median [interquartile range] serum testosterone (0.39 [0.31, 0.55] vs. 0.48 [0.33, 0.68] nmol/L), dehydroepiandrosterone (5.11 [3.29, 7.56] vs. 6.17 [4.33, 8.25] nmol/L), and androstenedione (1.06 [0.86, 1.46] vs. 1.29 [0.91, 1.85]). Testosterone and androstenedione were lower in peri-postmenopausal women with responsiveness difficulty (0.39 [0.29, 0.53] vs. 0.47 (0.33, 0.68) nmol/L and 1.08 (0.82, 1.46) vs. 1.28 (0.91, 1.84) nmol/L, respectively).

Testosterone and the preandrogens were not associated with sexual desire in midlife women. The associations between sex steroids and orgasm and arousal were complex and varied with menopausal status. Measurement of these sex steroids should not be part of the routine clinical assessment of women presenting with sexual concerns.