Low DHEA Levels Marker for Sexual Dysfunction in Older Women

NEW ORLEANS—Accumulating evidence has shown an association between sexual dysfunction in women and reduced levels of reproductive hormones, but how to treat it is not universally accepted. New data presented at the American Society for Reproductive Medicine annual meeting show that women with sexual dysfunction during the menopausal transition are twice as likely to have low levels of serum dehydroepiandrosterone sulfate (DHEA) as women with healthy sexual function.

These findings provide further evidence that physiologic causes of sexual dysfunction in women increase in prevalence during the menopausal transition, with symptoms of vaginal lubrication, orgasm, and arousal declining and dyspareunia (pain during intercourse) increasing.

Led by Clarisa Gracia, MD, MSCE, of the University of Pennsylvania Health System, Philadelphia, the investigators looked at the relationship between reproductive hormone levels and sexual function.

Overall, women with low DHEA levels were twice as likely to have sexual dysfunction as those with normal levels. A previous study showed that women in this age-group with decreased sexual responsiveness were 4 times as likely to have low DHEA levels as women with normal responsiveness.

“We found that women who complained of sexual dysfunction had much lower levels of DHEA compared with women who did not meet the criteria for sexual dysfunction,” said Dr Gracia. “We were expecting to see a difference in free testosterone levels or in the variability of testosterone levels. So we were surprised to find DHEA was the hormone we found to be different. DHEA is converted to testosterone and estrogen in the body, so it is hard to know what our findings mean at a cellular level.”

Of the 313 women (mean age, 49 years; mean body mass index, 31 kg/m²), 49% were black. At baseline:

• 144 (46%) were premenopausal

• 95 (30%) were in the early transition

• 40 (13%) were in the late transition

• 22 (7%) were postmenopausal

• 12 (4%) had undergone hysterectomy.

For 3 years, all the women were as­sessed at yearly intervals for various sex hormone levels. Several questionnaires were used, including the Female Sexual Function Index.

Sexual dysfunction was significantly associated with advanced menopausal stage, obesity, black race, having children <18 years living at home, anxiety, depression, and lack of a sexual partner. Other associated factors were smoking, alcohol use, and low DHEA levels.

No significant associations were seen between sexual function and levels of other reproductive hormones, including free testosterone. Overall, postmeno&shy;pausal women were 2.3 times more likely to experience sexual dysfunction than premenopausal women.

IMWR

&#8220;At this point there are no data to support prescribing or not prescribing DHEA for women with sexual dysfunction. We didn&#8217;t address treating women,&#8221; Dr Gracia told .

&#8220;The most important message is that while DHEA levels are associated with female sexual dysfunction, you should not be testing them clinically, because there are no clear cut-off levels that are useful in order to supplement women. There are a lot of products that are out there and sold as herbal supplements, but there are no good data yet to support the use of supplemental DHEA.&#8221;?

For the past few years, a debate has been raging among sexual experts about the use of natural products for the treatment of sexual dysfunction linked to low DHEA levels, with some strongly advocating use of supplements and some strongly objecting to it because of the potential side effects. The jury is still out on how best to treat this very common problem.