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Study of premenopausal women: low DHEA-S levels strongly tied to low libido.

NEW ORLEANS -- Low serum dehydroepiandrosterone sulfate is dramatically associated with low libido in premenopausal women, and appears to be a more accurate marker of decreased sexual interest than testosterone, Dr. Susan Davis said at the annual meeting of the Endocrine Society.

In a sample of more than 1,400 women, those who scored in the lowest 10% on a sexual function questionnaire were most likely to have serum dehydroepiandrosterone sulfate (DHEA-S) levels below the 10th percentile, said Dr. Davis, research director of the Jean Hailes Foundation in Clayton, Australia.

Free testosterone did not make an independent contribution to the risk of having a desire and arousal score below the 10th percentile, according to Dr. Davis.

"Although multiple factors contribute to sexual interest, we have demonstrated that low DHEA-S is more likely in a women experiencing low sexual desire and arousal than in other women," she said in a press conference at the meeting.

Dr. Davis recruited 1,432 women aged 18-75 years for her study; women on oral contraceptives were excluded. Each woman gave a morning blood sample and completed the Profile of Female Sexual Function.

Premenopausal women had their blood drawn after day 8 of their cycle but before menstruation. The blood was analyzed for circulating androgens.

In women under age 45, there was a very strong independent association of low desire, arousal, and responsiveness with low DHEA-S levels, but no independent association with those sexual domains and testosterone levels.

Low DHEA-S in these women didn't appear to affect their sexual behavior, Dr. Davis said. There was no association with orgasm or pleasure. For women aged 45 years and older, low serum DHEA-S levels were highly correlated with low sexual responsiveness.

"This study shows that low testosterone levels bear no significant relationship to low libido in women aged 18-75 years." Dr. Davis said. "It does appear that in young women, having a low level of DHEA-S is an independent predictor of low sexual desire, arousal, and sexual responsiveness. We did not find any correlation between other hormone levels and orgasm or pleasure, nor between testosterone levels and any of the questionnaire scores."

DHEA is available over the counter as a nutritional supplement, but there is little data to justify its wide use among women, she added. Treatment guidelines are mainly based on anecdotal experience and few published randomized studies have demonstrated any sustained therapeutic effects.

In fact, too much of the hormone may be just as bad as too little, said Dr. Anne Cappola of the University of Pennsylvania. Philadelphia. Dr. Cappola presented data showing that women aged 65-100 years with higher and low levels of DHEA-S have a higher risk of mortality than women with moderate levels.

She examined serum DHEA-S levels from 502 women; the levels were obtained during the Women's Health and Aging Study. She then analyzed the hormone levels in relation to mortality in the group over a 5-year period.

After adjusting for age and other variables (including race, smoking, and body mass index), Dr. Cappola found that women in the highest quartile had a 1.76 relative risk of dying during the 5-year period and those in the lowest quartile had a 1.83 relative risk, compared with women in the middle two quartiles.

Dr. Cappola did not break down the causes of death, but did point out that men with low DHEA-S levels have an increased risk of cardiovascular mortality. It's unknown if the development of the low hormone level is associated with the development of cardiovascular, or any other, disease.

"The question is, what is the underlying cause of producing more or less DHEA-S?" she said in an interview.

Because the higher death rates were at both ends of the curve, supplementation must be carefully weighed, as it may be dangerous in some as-yet-unidentified population, she said.


Mid-Atlantic Bureau
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Title Annotation:Gynecology
Author:Sullivan, Michele G.
Publication:OB GYN News
Date:Aug 15, 2004
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