The authors suspected their repeated finding of low DHEA reflected HPA axis dysregulation, “given that clinical histories of women with chronic low sexual desire frequently contain details of stressful childhoods and adolescence,” Dr. Basson said.
For the current study, when sexual function was measured categorically, HSDD subjects demonstrated significantly lower morning cortisol levels compared to control subjects: 8.20 nmol/L versus 9.36 nmol/L, respectively (P= 0.02).
“Research suggests that low basal levels of cortisol and blunted HPA activity might predispose to diseases or disorders, such as mental health problems and possible sexual disorders,” Dr. Basson said.
In summary, both hormonal deficiency (DHEA and cortisol) and the past stress that the deficiency is believed to reflect may contribute to low sexual desire. “Lower DHEA may lower mood and possibly act via other neurotransmission in the brain, due to its many as yet unexplored actions,” Dr. Basson said. “So supplementing DHEA could eventually be appropriate. But supplementing DHEA systemically is not yet recommended.”
Nonetheless, the study’s findings strongly encourage evaluating stress in the younger years of women with sexual low desire. Appropriate cognitive therapies and other treatment modalities for altering response to stress should also be advocated.
“We need randomized controlled trials of supplementing systemic DHEA in mid-life and older women with sexual interest/arousal disorder (SIAD) accompanied by low DHEA,” said Dr. Basson, noting that in 2013 the American Psychiatric Association replaced HSDD with SIAD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Dr. Basson reports no relevant financial disclosures.