The Effect of Testosterone on Sexual Arousal in Women

Abstract & Commentary

Synopsis: There is a lag in the effect of sublingually administered testosterone, perhaps due to the time it takes for neurophysiologic alterations in the brain.

Source: Tuiten A, et al. Arch Gen Psychiatry 2000;57:149-157.

Female sex steroids are necessary for the expression of sexual behavior in many mammals. Copulation is typically limited to the period of ovulation, except in higher primates (i.e., humans) who have sex outside the periovulatory period; testosterone is believed to be involved in this. A lack of testosterone (e.g., ovariectomy) is associated with a loss of libido, which is reversed upon replenishment.1-2 Physiological responses to sexual stimuli are an important aspect of sexual functioning, marked by vaginal vasocongestion. In females with hypothalamic amenorrhea, testosterone substitution enhanced vaginal responsiveness, but not in a parallel group with panhypopituitarism.3

Tuiten and colleagues investigated the effect of a single, sublingual dose of testosterone in eight sexually functional women on physiological and subjective sexual arousal, using a double-masked, randomized, placebo-controlled, crossover design. Participants were tested within 10 days of the end of their period of menstruation, with five days separating the two periods of treatment. Subjects were exposed to pornographic or neutral videotape at six time intervals: immediately before, 15 minutes after, and every one-and-a-half hours for six hours after testosterone administration. Blood levels of testosterone were measured at all six intervals. Within 15 minutes of testosterone intake, there was a 10-fold+ increase in total testosterone levels and a return to baseline within 90 minutes. Compared to placebo, testosterone significantly increased genital responsiveness four-and-one-half hours after peak levels and was associated with increased genital arousal, as well as subjective reports of genital sensations and sexual lust. Tuiten et al concluded there is a lag in the effect of sublingually administered testosterone, perhaps due to the time it takes for neurophysiologic alterations in the brain.

Comment by Donald M. Hilty, MD

Testosterone may have an important clinical role in terms of sexual functioning. In aging men, testosterone levels decline with age and are correlated with symptoms of depression. Testosterone replacement is being evaluated at the present time. In HIV-positive men who often have hypogonadal symptoms, testosterone is well-tolerated and appears to restore libido and energy.4 A recent study estimated that 43% of women suffer from sexual dysfunction, mainly low sexual desire (22%), sexual arousal problems (14%), and sexual pain (7%).5 Intermittent testosterone may be helpful, though the four-hour delay in response may be an impediment to use. The "correct" dose is yet unclear and its use has potential adverse events. At doses 4-8 times normal levels, 4% of patients may become hypomanic; at 8+ times normal levels, over 18% of patients demonstrated psychosis or euphoria.6 (Dr. Hilty is Assistant Professor of Clinical Psychiatry, University of California, Davis, Sacramento, CA.)

References

1. Waxenberg SE, et al. J Clin Endocrinol Metab 1959;19:193-202.

2. Dreilich MG, et al. Erotic and affectional components of female sexuality. In: Masserman J, ed. Science and Psycho-Analysis. Vol X: Sexuality of Women. New York, NY: Grune & Stratton, Inc; 1966:45-53.

3. Tuiten A, et al. Psychosom Med 1996;58:234-241.

4. Rabkin JG, et al. Arch Gen Psychiatry 2000;57:141-147.

5. Laumann EO, et al. JAMA 1999;281:537-544.

6. Pope HG, et al. Arch Gen Psychiatry 2000;57:133-140.

Compared to placebo, the use of testosterone in women:

a. significantly increased genital responsiveness four-and-one-half hours after peak levels.

b. was associated with increased genital arousal.

c. caused subjective reports of genital sensations and sexual lust.

d. All of the above