madman
Super Moderator
ABSTRACT
Estradiol (E2) has been implicated in sexual functioning in both sexes. E2 levels change distinctively over the menstrual cycle, peaking around ovulation. Data on the short-term effects of fluctuating E2 levels on sexual desire are however sparse and mostly based on observational studies. To fill this gap, we ran a double-blind, randomized, placebo-controlled study (N = 126) to investigate the effects of a short-term increase in E2 on sexual desire and orgasm frequency in healthy, young men and women. Circulating E2 levels were elevated through estradiol valerate (E2V) administered over two consecutive days to simulate the rise in E2 levels around ovulation. E2V had no effect on orgasm frequency and only minor effects on sexual desire. On average, the administered E2V dampened change in sexual desire compared to untreated participants with comparable baseline sexual desire in such a way that sexual desire was slightly reduced even in those with higher baseline sexual desire. These findings suggest that short-term increases in E2 have little effect on sexual function and are unlikely to explain the increase in sexual desire around ovulation.
A strength of our study is its interventional and blinded design, as most studies on the effects of E2 and P4 on sexual desire in women are either uncontrolled and only report associations of sexual desire and motivation with sex steroid levels in the course of the menstrual cycle (Roney and Simmons, 2013; Roney and Simmons, 2016), or investigated effects of hormonal contraceptives (Pastor et al., 2013) or long-term replacement therapies (Lobo, 2003). Additionally, there are few studies investigating the effects of supraphysiological E2 levels on sexual functioning in men, and our study therefore adds to this limited literature.
5. Limitations
As mentioned, two limitations of our study are we did not control for TST levels in men and the SDI-2 inventory did not differentiate between sexual interest in one’s own partner or others. A further limitation is that this study was part of a larger project investigating the effects of estradiol on a variety of behaviors and neurocognitive functions, some of which might have been stressful for participants and therefore have affected sexual functioning. Most notably, participants performed an elevated plus-maze task in a virtual reality environment (Nouri, 2022) designed to assess anxiety and hence increase stress levels in participants. While stress can affect sexual desire, and sex steroids can interact with the physiological stress response (Fuss, 2019), empirical findings on the association between sexual variables and measures of stress (e.g.,self-reports, cortisol levels) are mixed, with some studies showing that stress is positively associated with sexual activity (Goldey and vanAnders, 2012; Lopez ´ et al., 2009) while others showing that stress is negatively associated with sexual activity or functioning (Bodenmann,2010; Ein-Dor and Hirschberger, 2012). These mixed findings might stem from differences in how stress is measured, notably, that measures of self-reported stress and cortisol diverge (Rosal, 2004). Participants have reported that partnered sexual desire is negatively correlated with stress (Carvalheira et al., 2014). While even fewer studies have investigated how psychological stress affects solitary desire, some research suggests that the desire to masturbate increases when one is stressed or needs to relax. Similarly, a lower desire for sexual activity with a partner and a greater desire to engage in solitary sexual activity is associated with stressful conditions (Graham, 2004).
We have recently shown in the same cohort that E2V treatment reduced physiological indicators of stress such as increased heart rate and increased cortisol levels during a virtual stress paradigm (Nouri,2022). In contrast, in another study from our group, androgen withdrawal and E2 treatment in transgender women were associated with an exaggerated stress response to a pharmacological stimulus, while the opposite was true for TST treatment in transgender men (Fuss, 2019)
6. Conclusion
Overall, our study indicates that high E2 levels, irrespective of sex, have only a marginal acute effect on sexual desire, and this slight effect might be influenced by a concomitant decrease in TST in men. Our results make it unlikely that the increase in sexual desire around ovulation is primarily caused by the acute rise in E2 levels in women. However, further studies should investigate how sexual desire is influenced by increasing E2 levels when TST levels are kept stable in order to rule out that suppressed TST levels are responsible for the marginal effects of E2V.
Estradiol (E2) has been implicated in sexual functioning in both sexes. E2 levels change distinctively over the menstrual cycle, peaking around ovulation. Data on the short-term effects of fluctuating E2 levels on sexual desire are however sparse and mostly based on observational studies. To fill this gap, we ran a double-blind, randomized, placebo-controlled study (N = 126) to investigate the effects of a short-term increase in E2 on sexual desire and orgasm frequency in healthy, young men and women. Circulating E2 levels were elevated through estradiol valerate (E2V) administered over two consecutive days to simulate the rise in E2 levels around ovulation. E2V had no effect on orgasm frequency and only minor effects on sexual desire. On average, the administered E2V dampened change in sexual desire compared to untreated participants with comparable baseline sexual desire in such a way that sexual desire was slightly reduced even in those with higher baseline sexual desire. These findings suggest that short-term increases in E2 have little effect on sexual function and are unlikely to explain the increase in sexual desire around ovulation.
A strength of our study is its interventional and blinded design, as most studies on the effects of E2 and P4 on sexual desire in women are either uncontrolled and only report associations of sexual desire and motivation with sex steroid levels in the course of the menstrual cycle (Roney and Simmons, 2013; Roney and Simmons, 2016), or investigated effects of hormonal contraceptives (Pastor et al., 2013) or long-term replacement therapies (Lobo, 2003). Additionally, there are few studies investigating the effects of supraphysiological E2 levels on sexual functioning in men, and our study therefore adds to this limited literature.
5. Limitations
As mentioned, two limitations of our study are we did not control for TST levels in men and the SDI-2 inventory did not differentiate between sexual interest in one’s own partner or others. A further limitation is that this study was part of a larger project investigating the effects of estradiol on a variety of behaviors and neurocognitive functions, some of which might have been stressful for participants and therefore have affected sexual functioning. Most notably, participants performed an elevated plus-maze task in a virtual reality environment (Nouri, 2022) designed to assess anxiety and hence increase stress levels in participants. While stress can affect sexual desire, and sex steroids can interact with the physiological stress response (Fuss, 2019), empirical findings on the association between sexual variables and measures of stress (e.g.,self-reports, cortisol levels) are mixed, with some studies showing that stress is positively associated with sexual activity (Goldey and vanAnders, 2012; Lopez ´ et al., 2009) while others showing that stress is negatively associated with sexual activity or functioning (Bodenmann,2010; Ein-Dor and Hirschberger, 2012). These mixed findings might stem from differences in how stress is measured, notably, that measures of self-reported stress and cortisol diverge (Rosal, 2004). Participants have reported that partnered sexual desire is negatively correlated with stress (Carvalheira et al., 2014). While even fewer studies have investigated how psychological stress affects solitary desire, some research suggests that the desire to masturbate increases when one is stressed or needs to relax. Similarly, a lower desire for sexual activity with a partner and a greater desire to engage in solitary sexual activity is associated with stressful conditions (Graham, 2004).
We have recently shown in the same cohort that E2V treatment reduced physiological indicators of stress such as increased heart rate and increased cortisol levels during a virtual stress paradigm (Nouri,2022). In contrast, in another study from our group, androgen withdrawal and E2 treatment in transgender women were associated with an exaggerated stress response to a pharmacological stimulus, while the opposite was true for TST treatment in transgender men (Fuss, 2019)
6. Conclusion
Overall, our study indicates that high E2 levels, irrespective of sex, have only a marginal acute effect on sexual desire, and this slight effect might be influenced by a concomitant decrease in TST in men. Our results make it unlikely that the increase in sexual desire around ovulation is primarily caused by the acute rise in E2 levels in women. However, further studies should investigate how sexual desire is influenced by increasing E2 levels when TST levels are kept stable in order to rule out that suppressed TST levels are responsible for the marginal effects of E2V.
