title: Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels.
abstract: OBJECTIVE
  An unknown proportion of transsexual women (defined as post-operative male-to-female transsexuals on oestrogen replacement) experience hypoactive sexual desire disorder (HSDD). It has been suggested that the absence of ovarian androgen production together with oestrogen treatment-related increase in sex hormone-binding globulin (SHBG) levels could be leading to HSDD, due to low levels of biologically available testosterone. This study wishes to document the HSDD prevalence among transsexual women and the possible association to androgen levels.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Transsexual women (n=62) and a control group of ovulating women (n=30) participated in this study. Questionnaires measuring sexual desire (sexual desire inventory) and relationship and sexual satisfaction (Maudsley Marital Questionnaire) were completed. Serum levels of total testosterone, LH and SHBG were measured in blood samples obtained at random in transsexual women and in the early follicular phase in ovulating women.
  
  
  RESULTS
  The transsexual group had lower levels of total and calculated free testosterone (both P<0.001) than the ovulating women. HSDD was reported in 34% of the transsexual and 23% of the ovulating women (P=0.30). Both groups reported similar levels of sexual desire (P=0.97). For transsexual women, no significant correlation was found between sexual desire and total (P=0.64) or free testosterone (P=0.82). In ovulating women, these correlations were significant (P=0.006, resp. P=0.003).
  
  
  CONCLUSIONS
  HSDD is reported in one-third of transsexual women. This prevalence is not substantially different from controls, despite markedly lower (free) testosterone levels, which argues against a major role of testosterone in this specific group.
authors.affiliation: Department of Sexology and Gender Problems, Ghent University Hospital, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Elaut
authors.forename: Griet
authors.initials: G
authors.lastname: De Cuypere
authors.forename: Petra
authors.initials: P
authors.lastname: De Sutter
authors.forename: Luk
authors.initials: L
authors.lastname: Gijs
authors.forename: Michael
authors.initials: M
authors.lastname: Van Trotsenburg
authors.forename: Gunter
authors.initials: G
authors.lastname: Heylens
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Kaufman
authors.forename: Robert
authors.initials: R
authors.lastname: Rubens
authors.forename: Guy
authors.initials: G
authors.lastname: T'Sjoen
mesh_terms: D000293:Adolescent; D000328:Adult; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007989:Libido / Q000502:physiology*; D008875:Middle Aged; D010060:Ovulation; D015995:Prevalence; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D012735:Sexual Dysfunction, Physiological / Q000097:blood / Q000453:epidemiology*; D013739:Testosterone / Q000097:blood*
chemical_list: D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D019314:Dehydroepiandrosterone Sulfate