Sex, hormones and the brain

The human sexual response is a complicated biopsychosocial phenomenon in which internal and external stimuli are modulated by the central and peripheral nervous system, resulting in a cascade of biochemical, hormonal and circulatory changes that lead to cognitive and physical sexual arousal. In this article, current knowledge of the relationships between central processes, mediated by neuropeptides and neurotransmitters, and the hypothalamo-pituitary-gonadal axis is explored. Hormonal aspects of sexual arousability and sexual excitement are mainly related to androgens. The possible influences of hormonal therapies such as hormonal contraception and perimenopausal hormone substitution are described. The main conclusion is that clinicians should be aware of possible sexual problems resulting from changes in circulating sex hormone binding globulin and free testosterone in men and women due to endogenous or exogenous hormonal changes.