Decreased Libido Decreased sexual drive. Libido appears to be testosterone-dependent in both women and men. In women, ovarian hormones and adrenal androgens begin to decrease in the years preceding menopause. A decrease or loss of libido along with a diminished sense of well-being, loss of energy, and loss of bone mass can result. Additionally, use of alcohol or drugs may affect sexuality in women.
Incontinence can also decrease libido and inhibit arousal.
In evaluating decreased libido in women, as in men, the physician should measure bioavailable testosterone levels rather than total testosterone levels. Sex hormone-binding globulin levels tend to increase with age, and total testosterone levels may not reflect what is actually active in the body. Bioavailable testosterone measures the nonsex hormone-binding globulin bound portion of testosterone. Women with decreased libido may benefit from androgen therapy if baseline testosterone levels are low. Duration of treatment depends on response and whether withdrawal of testosterone results in recurrence of problems.