Skip to main content
Erschienen in: Gynäkologische Endokrinologie 3/2017

05.07.2017 | Sexualität | Leitthema

Androgene und weibliche Libido

verfasst von: PD Dr. Gideon Sartorius

Erschienen in: Gynäkologische Endokrinologie | Ausgabe 3/2017

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

Ein Libidomangel ist bei Frauen häufig – und führt nicht selten zu ärztlichen Konsultationen mit der Bitte um eine ursächliche Behandlung mit Androgenen.

Fragestellung

Besteht ein Zusammenhang zwischen Androgenen und weiblicher Sexualität? Ist eine Androgensubstitution zur Behandlung von Libidostörungen gerechtfertigt?

Material und Methoden

Narrative Übersichtsarbeit nach Auswertung der Literatur, die im Rahmen einer unsystematischen, aber ausgiebigen MEDLINE-Literatursuche (Stichworte: Androgene, Präandrogene, Testosteron, Hormonersatz UND weibliche Libido, Libidomangel [HSDD], weibliche Sexualität) für den Zeitraum Januar 2006 bis April 2017 durchgeführt wurde. Dabei wurden auch ältere Arbeiten aus den jeweiligen Literaturverzeichnissen herangezogen.

Ergebnisse

Androgene korrelieren schwach mit der weiblichen Libido, wobei die Messung der Androgenkonzentration im peripheren Blut nicht diagnostisch verwertet werden kann. Obwohl die Testosteronbehandlung bei bestimmten Frauen mit störendem Libidomangel therapeutisch effektiv sein kann, gibt es in der Regel keine zugelassenen Testosteronprodukte für Frauen auf dem Markt. Zudem gibt es nur wenige Daten zu Langzeitnebenwirkungen der Testosteronsubstitution.

Schlussfolgerung

Es ist hilfreich, wenn in Diagnostik und Therapie die multifaktorielle Natur der Sexualität berücksichtigt wird, damit biologische, psychologisch-emotionale, partnerschaftliche und soziokulturelle Aspekte in die Behandlung einfließen können.
Literatur
1.
Zurück zum Zitat Alder EM, Cook A, Davidson D et al (1986) Hormones, mood and sexuality in lactating women. Br J Psychiatry 148:74–79 CrossRefPubMed Alder EM, Cook A, Davidson D et al (1986) Hormones, mood and sexuality in lactating women. Br J Psychiatry 148:74–79 CrossRefPubMed
2.
Zurück zum Zitat Alexander BM, Skinner DC, Roselli CE (2011) Wired on steroids: sexual differentiation of the brain and its role in the expression of sexual partner preferences. Front Endocrinol (Lausanne) 2:42 Alexander BM, Skinner DC, Roselli CE (2011) Wired on steroids: sexual differentiation of the brain and its role in the expression of sexual partner preferences. Front Endocrinol (Lausanne) 2:42
3.
Zurück zum Zitat Aziz A, Brannstrom M, Bergquist C et al (2005) Perimenopausal androgen decline after oophorectomy does not influence sexuality or psychological well-being. Fertil Steril 83:1021–1028 CrossRefPubMed Aziz A, Brannstrom M, Bergquist C et al (2005) Perimenopausal androgen decline after oophorectomy does not influence sexuality or psychological well-being. Fertil Steril 83:1021–1028 CrossRefPubMed
4.
Zurück zum Zitat Bancroft J, Cawood EH (1996) Androgens and the menopause; a study of 40–60-year-old women. Clin Endocrinol (Oxf) 45:577–587 CrossRef Bancroft J, Cawood EH (1996) Androgens and the menopause; a study of 40–60-year-old women. Clin Endocrinol (Oxf) 45:577–587 CrossRef
5.
Zurück zum Zitat Basson R, Brotto LA, Petkau AJ et al (2010) Role of androgens in women’s sexual dysfunction. Menopause 17:962–971 CrossRefPubMed Basson R, Brotto LA, Petkau AJ et al (2010) Role of androgens in women’s sexual dysfunction. Menopause 17:962–971 CrossRefPubMed
6.
Zurück zum Zitat Blakemore J, Naftolin F (2016) Aromatase: contributions to physiology and disease in women and men. Physiology (Bethesda) 31:258–269 Blakemore J, Naftolin F (2016) Aromatase: contributions to physiology and disease in women and men. Physiology (Bethesda) 31:258–269
7.
Zurück zum Zitat Brotto LA, Petkau AJ, Labrie F et al (2011) Predictors of sexual desire disorders in women. J Sex Med 8:742–753 CrossRefPubMed Brotto LA, Petkau AJ, Labrie F et al (2011) Predictors of sexual desire disorders in women. J Sex Med 8:742–753 CrossRefPubMed
8.
Zurück zum Zitat Cain VS, Johannes CB, Avis NE et al (2003) Sexual functioning and practices in a multi-ethnic study of midlife women: baseline results from SWAN. J Sex Res 40:266–276 CrossRefPubMed Cain VS, Johannes CB, Avis NE et al (2003) Sexual functioning and practices in a multi-ethnic study of midlife women: baseline results from SWAN. J Sex Res 40:266–276 CrossRefPubMed
9.
Zurück zum Zitat Claessens F, Joniau S, Helsen C (2017) Comparing the rules of engagement of androgen and glucocorticoid receptors. Cell Mol Life Sci 74:2217–2228 CrossRefPubMedPubMedCentral Claessens F, Joniau S, Helsen C (2017) Comparing the rules of engagement of androgen and glucocorticoid receptors. Cell Mol Life Sci 74:2217–2228 CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Davis SR, Davison SL, Donath S et al (2005) Circulating androgen levels and self-reported sexual function in women. JAMA 294:91–96 CrossRefPubMed Davis SR, Davison SL, Donath S et al (2005) Circulating androgen levels and self-reported sexual function in women. JAMA 294:91–96 CrossRefPubMed
11.
Zurück zum Zitat Davis SR, Moreau M, Kroll R et al (2008) Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med 359:2005–2017 CrossRefPubMed Davis SR, Moreau M, Kroll R et al (2008) Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med 359:2005–2017 CrossRefPubMed
12.
Zurück zum Zitat Davis SR, Panjari M, Stanczyk FZ (2011) Clinical review: DHEA replacement for postmenopausal women. J Clin Endocrinol Metab 96:1642–1653 CrossRefPubMed Davis SR, Panjari M, Stanczyk FZ (2011) Clinical review: DHEA replacement for postmenopausal women. J Clin Endocrinol Metab 96:1642–1653 CrossRefPubMed
13.
Zurück zum Zitat Davis SR, Wahlin-Jacobsen S (2015) Testosterone in women – the clinical significance. Lancet Diabetes Endocrinol 3:980–992 CrossRefPubMed Davis SR, Wahlin-Jacobsen S (2015) Testosterone in women – the clinical significance. Lancet Diabetes Endocrinol 3:980–992 CrossRefPubMed
14.
Zurück zum Zitat Davis SR, Worsley R, Miller KK et al (2016) Androgens and female sexual function and dysfunction – findings from the fourth international consultation of sexual medicine. J Sex Med 13:168–178 CrossRefPubMed Davis SR, Worsley R, Miller KK et al (2016) Androgens and female sexual function and dysfunction – findings from the fourth international consultation of sexual medicine. J Sex Med 13:168–178 CrossRefPubMed
15.
Zurück zum Zitat Davison SL, Bell R, Donath S et al (2005) Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab 90:3847–3853 CrossRefPubMed Davison SL, Bell R, Donath S et al (2005) Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab 90:3847–3853 CrossRefPubMed
16.
Zurück zum Zitat Dennerstein L, Dudley E, Burger H (2001) Are changes in sexual functioning during midlife due to aging or menopause? Fertil Steril 76:456–460 CrossRefPubMed Dennerstein L, Dudley E, Burger H (2001) Are changes in sexual functioning during midlife due to aging or menopause? Fertil Steril 76:456–460 CrossRefPubMed
17.
18.
Zurück zum Zitat Elraiyah T, Sonbol MB, Wang Z et al (2014) Clinical review: The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab 99:3536–3542 CrossRefPubMedPubMedCentral Elraiyah T, Sonbol MB, Wang Z et al (2014) Clinical review: The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab 99:3536–3542 CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Elraiyah T, Sonbol MB, Wang Z et al (2014) Clinical review: The benefits and harms of systemic testosterone therapy in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab 99:3543–3550 CrossRefPubMedPubMedCentral Elraiyah T, Sonbol MB, Wang Z et al (2014) Clinical review: The benefits and harms of systemic testosterone therapy in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab 99:3543–3550 CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Garcia-Falgueras A, Swaab DF (2010) Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation. Endocr Dev 17:22–35 CrossRefPubMed Garcia-Falgueras A, Swaab DF (2010) Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation. Endocr Dev 17:22–35 CrossRefPubMed
21.
Zurück zum Zitat Graziottin A, Koochaki PE, Rodenberg CA et al (2009) The prevalence of hypoactive sexual desire disorder in surgically menopausal women: an epidemiological study of women in four European countries. J Sex Med 6:2143–2153 CrossRefPubMed Graziottin A, Koochaki PE, Rodenberg CA et al (2009) The prevalence of hypoactive sexual desire disorder in surgically menopausal women: an epidemiological study of women in four European countries. J Sex Med 6:2143–2153 CrossRefPubMed
22.
Zurück zum Zitat Handelsman DJ (2000) Androgen physiology, pharmacology and abuse. In: De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A (Hrsg) Endotext. http://​www.​endotext.​org, South Dartmouth MA Handelsman DJ (2000) Androgen physiology, pharmacology and abuse. In: De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A (Hrsg) Endotext. http://​www.​endotext.​org, South Dartmouth MA
23.
Zurück zum Zitat Labrie F, Belanger A, Belanger P et al (2006) Androgen glucuronides, instead of testosterone, as the new markers of androgenic activity in women. J Steroid Biochem Mol Biol 99:182–188 CrossRefPubMed Labrie F, Belanger A, Belanger P et al (2006) Androgen glucuronides, instead of testosterone, as the new markers of androgenic activity in women. J Steroid Biochem Mol Biol 99:182–188 CrossRefPubMed
24.
Zurück zum Zitat Labrie F, Belanger A, Pelletier G et al (2017) Science of intracrinology in postmenopausal women. Menopause 24(6):702–712 CrossRefPubMed Labrie F, Belanger A, Pelletier G et al (2017) Science of intracrinology in postmenopausal women. Menopause 24(6):702–712 CrossRefPubMed
25.
Zurück zum Zitat Laumann EO, Paik A, Rosen RC (1999) Sexual dysfunction in the United States: prevalence and predictors. JAMA 281:537–544 CrossRefPubMed Laumann EO, Paik A, Rosen RC (1999) Sexual dysfunction in the United States: prevalence and predictors. JAMA 281:537–544 CrossRefPubMed
26.
Zurück zum Zitat Mccoy NL, Davidson JM (1985) A longitudinal study of the effects of menopause on sexuality. Maturitas 7:203–210 CrossRefPubMed Mccoy NL, Davidson JM (1985) A longitudinal study of the effects of menopause on sexuality. Maturitas 7:203–210 CrossRefPubMed
27.
Zurück zum Zitat Mcrobb L, Handelsman DJ, Kazlauskas R et al (2008) Structure-activity relationships of synthetic progestins in a yeast-based in vitro androgen bioassay. J Steroid Biochem Mol Biol 110:39–47 CrossRefPubMed Mcrobb L, Handelsman DJ, Kazlauskas R et al (2008) Structure-activity relationships of synthetic progestins in a yeast-based in vitro androgen bioassay. J Steroid Biochem Mol Biol 110:39–47 CrossRefPubMed
28.
Zurück zum Zitat Nathorst-Boos J, Von Schoultz B (1992) Psychological reactions and sexual life after hysterectomy with and without oophorectomy. Gynecol Obstet Invest 34:97–101 CrossRefPubMed Nathorst-Boos J, Von Schoultz B (1992) Psychological reactions and sexual life after hysterectomy with and without oophorectomy. Gynecol Obstet Invest 34:97–101 CrossRefPubMed
29.
Zurück zum Zitat Nicolosi A, Laumann EO, Glasser DB et al (2004) Sexual behavior and sexual dysfunctions after age 40: The global study of sexual attitudes and behaviors. Urology 64:991–997 CrossRefPubMed Nicolosi A, Laumann EO, Glasser DB et al (2004) Sexual behavior and sexual dysfunctions after age 40: The global study of sexual attitudes and behaviors. Urology 64:991–997 CrossRefPubMed
30.
Zurück zum Zitat Randolph JF Jr., Zheng H, Avis NE et al (2015) Masturbation frequency and sexual function domains are associated with serum reproductive hormone levels across the menopausal transition. J Clin Endocrinol Metab 100:258–266 CrossRefPubMed Randolph JF Jr., Zheng H, Avis NE et al (2015) Masturbation frequency and sexual function domains are associated with serum reproductive hormone levels across the menopausal transition. J Clin Endocrinol Metab 100:258–266 CrossRefPubMed
31.
Zurück zum Zitat Rey R, Josso N, Racine C (2000) Sexual differentiation. In: De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A (Hrsg) Endotext. http://​www.​endotext.​org, South Dartmouth MA Rey R, Josso N, Racine C (2000) Sexual differentiation. In: De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A (Hrsg) Endotext. http://​www.​endotext.​org, South Dartmouth MA
32.
Zurück zum Zitat Rhodes JC, Kjerulff KH, Langenberg PW et al (1999) Hysterectomy and sexual functioning. JAMA 282:1934–1941 CrossRefPubMed Rhodes JC, Kjerulff KH, Langenberg PW et al (1999) Hysterectomy and sexual functioning. JAMA 282:1934–1941 CrossRefPubMed
33.
Zurück zum Zitat Rochira V, Balestrieri A, Madeo B et al (2002) Congenital estrogen deficiency in men: a new syndrome with different phenotypes; clinical and therapeutic implications in men. Mol Cell Endocrinol 193:19–28 CrossRefPubMed Rochira V, Balestrieri A, Madeo B et al (2002) Congenital estrogen deficiency in men: a new syndrome with different phenotypes; clinical and therapeutic implications in men. Mol Cell Endocrinol 193:19–28 CrossRefPubMed
34.
Zurück zum Zitat Rosen R, Brown C, Heiman J et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208 CrossRefPubMed Rosen R, Brown C, Heiman J et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208 CrossRefPubMed
35.
Zurück zum Zitat Rothman MS, Carlson NE, Xu M et al (2011) Reexamination of testosterone, dihydrotestosterone, estradiol and estrone levels across the menstrual cycle and in postmenopausal women measured by liquid chromatography-tandem mass spectrometry. Steroids 76:177–182 CrossRefPubMed Rothman MS, Carlson NE, Xu M et al (2011) Reexamination of testosterone, dihydrotestosterone, estradiol and estrone levels across the menstrual cycle and in postmenopausal women measured by liquid chromatography-tandem mass spectrometry. Steroids 76:177–182 CrossRefPubMed
36.
Zurück zum Zitat Clapauch RRVW, Zilio Rech CM (2017) Testosterone and women. In: Hohl A (Hrsg) Testosterone – from basic to clinical aspects. Springer, Cham Clapauch RRVW, Zilio Rech CM (2017) Testosterone and women. In: Hohl A (Hrsg) Testosterone – from basic to clinical aspects. Springer, Cham
37.
Zurück zum Zitat Santoro N, Worsley R, Miller KK et al (2016) Role of estrogens and estrogen-like compounds in female sexual function and dysfunction. J Sex Med 13:305–316 CrossRefPubMed Santoro N, Worsley R, Miller KK et al (2016) Role of estrogens and estrogen-like compounds in female sexual function and dysfunction. J Sex Med 13:305–316 CrossRefPubMed
38.
Zurück zum Zitat Sartorius G, Ly LP, Sikaris K et al (2009) Predictive accuracy and sources of variability in calculated free testosterone estimates. Ann Clin Biochem 46:137–143 CrossRefPubMed Sartorius G, Ly LP, Sikaris K et al (2009) Predictive accuracy and sources of variability in calculated free testosterone estimates. Ann Clin Biochem 46:137–143 CrossRefPubMed
39.
Zurück zum Zitat Shifren JL, Avis NE (2007) Surgical menopause: effects on psychological well-being and sexuality. Menopause 14:586–591 CrossRefPubMed Shifren JL, Avis NE (2007) Surgical menopause: effects on psychological well-being and sexuality. Menopause 14:586–591 CrossRefPubMed
40.
Zurück zum Zitat Wahlin-Jacobsen S, Pedersen AT, Kristensen E et al (2015) Is there a correlation between androgens and sexual desire in women? J Sex Med 12:358–373 CrossRefPubMed Wahlin-Jacobsen S, Pedersen AT, Kristensen E et al (2015) Is there a correlation between androgens and sexual desire in women? J Sex Med 12:358–373 CrossRefPubMed
41.
Zurück zum Zitat Wang F, Pan J, Liu Y et al (2015) Alternative splicing of the androgen receptor in polycystic ovary syndrome. Proc Natl Acad Sci U S A 112:4743–4748 CrossRefPubMedPubMedCentral Wang F, Pan J, Liu Y et al (2015) Alternative splicing of the androgen receptor in polycystic ovary syndrome. Proc Natl Acad Sci U S A 112:4743–4748 CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat Wierman ME, Arlt W, Basson R et al (2014) Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 99:3489–3510 CrossRefPubMed Wierman ME, Arlt W, Basson R et al (2014) Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 99:3489–3510 CrossRefPubMed
43.
Zurück zum Zitat Zussman L, Zussman S, Sunley R et al (1981) Sexual response after hysterectomy-oophorectomy: recent studies and reconsideration of psychogenesis. Am J Obstet Gynecol 140:725–729 CrossRefPubMed Zussman L, Zussman S, Sunley R et al (1981) Sexual response after hysterectomy-oophorectomy: recent studies and reconsideration of psychogenesis. Am J Obstet Gynecol 140:725–729 CrossRefPubMed
Metadaten
Titel
Androgene und weibliche Libido
verfasst von
PD Dr. Gideon Sartorius
Publikationsdatum
05.07.2017
Verlag
Springer Medizin
Erschienen in
Gynäkologische Endokrinologie / Ausgabe 3/2017
Print ISSN: 1610-2894
Elektronische ISSN: 1610-2908
DOI
https://doi.org/10.1007/s10304-017-0137-z

Weitere Artikel der Ausgabe 3/2017

Gynäkologische Endokrinologie 3/2017 Zur Ausgabe

Mitteilungen der DMG

Mitteilungen der DMG

Neu im Fachgebiet Allgemeinmedizin

Update Allgemeinmedizin

Update Allgemeinmedizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.