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Erschienen in: Gynäkologische Endokrinologie 3/2017

05.07.2017 | Hormonsubstitution | Leitthema

Androgene und weibliche Libido

verfasst von: PD Dr. Gideon Sartorius

Erschienen in: Gynäkologische Endokrinologie | Ausgabe 3/2017

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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 148:74–79CrossRefPubMed Alder EM, Cook A, Davidson D et al (1986) Hormones, mood and sexuality in lactating women. Br J Psychiatry 148:74–79CrossRefPubMed
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 83:1021–1028CrossRefPubMed Aziz A, Brannstrom M, Bergquist C et al (2005) Perimenopausal androgen decline after oophorectomy does not influence sexuality or psychological well-being. Fertil Steril 83:1021–1028CrossRefPubMed
4.
Zurück zum Zitat Bancroft J, Cawood EH (1996) Androgens and the menopause; a study of 40–60-year-old women. Clin Endocrinol (Oxf) 45:577–587CrossRef Bancroft J, Cawood EH (1996) Androgens and the menopause; a study of 40–60-year-old women. Clin Endocrinol (Oxf) 45:577–587CrossRef
5.
Zurück zum Zitat Basson R, Brotto LA, Petkau AJ et al (2010) Role of androgens in women’s sexual dysfunction. Menopause 17:962–971CrossRefPubMed Basson R, Brotto LA, Petkau AJ et al (2010) Role of androgens in women’s sexual dysfunction. Menopause 17:962–971CrossRefPubMed
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 8:742–753CrossRefPubMed Brotto LA, Petkau AJ, Labrie F et al (2011) Predictors of sexual desire disorders in women. J Sex Med 8:742–753CrossRefPubMed
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 40:266–276CrossRefPubMed 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 40:266–276CrossRefPubMed
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 74:2217–2228CrossRefPubMedPubMedCentral Claessens F, Joniau S, Helsen C (2017) Comparing the rules of engagement of androgen and glucocorticoid receptors. Cell Mol Life Sci 74:2217–2228CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Davis SR, Davison SL, Donath S et al (2005) Circulating androgen levels and self-reported sexual function in women. JAMA 294:91–96CrossRefPubMed Davis SR, Davison SL, Donath S et al (2005) Circulating androgen levels and self-reported sexual function in women. JAMA 294:91–96CrossRefPubMed
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 359:2005–2017CrossRefPubMed Davis SR, Moreau M, Kroll R et al (2008) Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med 359:2005–2017CrossRefPubMed
12.
Zurück zum Zitat Davis SR, Panjari M, Stanczyk FZ (2011) Clinical review: DHEA replacement for postmenopausal women. J Clin Endocrinol Metab 96:1642–1653CrossRefPubMed Davis SR, Panjari M, Stanczyk FZ (2011) Clinical review: DHEA replacement for postmenopausal women. J Clin Endocrinol Metab 96:1642–1653CrossRefPubMed
13.
Zurück zum Zitat Davis SR, Wahlin-Jacobsen S (2015) Testosterone in women – the clinical significance. Lancet Diabetes Endocrinol 3:980–992CrossRefPubMed Davis SR, Wahlin-Jacobsen S (2015) Testosterone in women – the clinical significance. Lancet Diabetes Endocrinol 3:980–992CrossRefPubMed
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 13:168–178CrossRefPubMed 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 13:168–178CrossRefPubMed
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 90:3847–3853CrossRefPubMed Davison SL, Bell R, Donath S et al (2005) Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab 90:3847–3853CrossRefPubMed
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 76:456–460CrossRefPubMed Dennerstein L, Dudley E, Burger H (2001) Are changes in sexual functioning during midlife due to aging or menopause? Fertil Steril 76:456–460CrossRefPubMed
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 99:3536–3542CrossRefPubMedPubMedCentral 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 99:3536–3542CrossRefPubMedPubMedCentral
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 99:3543–3550CrossRefPubMedPubMedCentral 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 99:3543–3550CrossRefPubMedPubMedCentral
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 17:22–35CrossRefPubMed Garcia-Falgueras A, Swaab DF (2010) Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation. Endocr Dev 17:22–35CrossRefPubMed
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 6:2143–2153CrossRefPubMed 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 6:2143–2153CrossRefPubMed
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 99:182–188CrossRefPubMed 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 99:182–188CrossRefPubMed
24.
Zurück zum Zitat Labrie F, Belanger A, Pelletier G et al (2017) Science of intracrinology in postmenopausal women. Menopause 24(6):702–712CrossRefPubMed Labrie F, Belanger A, Pelletier G et al (2017) Science of intracrinology in postmenopausal women. Menopause 24(6):702–712CrossRefPubMed
25.
Zurück zum Zitat Laumann EO, Paik A, Rosen RC (1999) Sexual dysfunction in the United States: prevalence and predictors. JAMA 281:537–544CrossRefPubMed Laumann EO, Paik A, Rosen RC (1999) Sexual dysfunction in the United States: prevalence and predictors. JAMA 281:537–544CrossRefPubMed
26.
Zurück zum Zitat Mccoy NL, Davidson JM (1985) A longitudinal study of the effects of menopause on sexuality. Maturitas 7:203–210CrossRefPubMed Mccoy NL, Davidson JM (1985) A longitudinal study of the effects of menopause on sexuality. Maturitas 7:203–210CrossRefPubMed
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 110:39–47CrossRefPubMed 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 110:39–47CrossRefPubMed
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 34:97–101CrossRefPubMed Nathorst-Boos J, Von Schoultz B (1992) Psychological reactions and sexual life after hysterectomy with and without oophorectomy. Gynecol Obstet Invest 34:97–101CrossRefPubMed
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 64:991–997CrossRefPubMed 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 64:991–997CrossRefPubMed
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 100:258–266CrossRefPubMed 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 100:258–266CrossRefPubMed
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 282:1934–1941CrossRefPubMed Rhodes JC, Kjerulff KH, Langenberg PW et al (1999) Hysterectomy and sexual functioning. JAMA 282:1934–1941CrossRefPubMed
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 193:19–28CrossRefPubMed 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 193:19–28CrossRefPubMed
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 26:191–208CrossRefPubMed 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 26:191–208CrossRefPubMed
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 76:177–182CrossRefPubMed 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 76:177–182CrossRefPubMed
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 13:305–316CrossRefPubMed 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 13:305–316CrossRefPubMed
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 46:137–143CrossRefPubMed Sartorius G, Ly LP, Sikaris K et al (2009) Predictive accuracy and sources of variability in calculated free testosterone estimates. Ann Clin Biochem 46:137–143CrossRefPubMed
39.
Zurück zum Zitat Shifren JL, Avis NE (2007) Surgical menopause: effects on psychological well-being and sexuality. Menopause 14:586–591CrossRefPubMed Shifren JL, Avis NE (2007) Surgical menopause: effects on psychological well-being and sexuality. Menopause 14:586–591CrossRefPubMed
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 12:358–373CrossRefPubMed Wahlin-Jacobsen S, Pedersen AT, Kristensen E et al (2015) Is there a correlation between androgens and sexual desire in women? J Sex Med 12:358–373CrossRefPubMed
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 112:4743–4748CrossRefPubMedPubMedCentral 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 112:4743–4748CrossRefPubMedPubMedCentral
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 99:3489–3510CrossRefPubMed 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 99:3489–3510CrossRefPubMed
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 140:725–729CrossRefPubMed Zussman L, Zussman S, Sunley R et al (1981) Sexual response after hysterectomy-oophorectomy: recent studies and reconsideration of psychogenesis. Am J Obstet Gynecol 140:725–729CrossRefPubMed
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

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