Sexuality and Fertility in Women With Addison's Disease

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Although there is a deficiency of circulating androgens among women with Addison's disease, it is unclear whether androgen replacement therapy improves their sexual functioning. It is also unclear whether women with Addison's disease have low libido or impaired sexual function. Androgen replacement studies evaluating the effects of testosterone or the adrenal androgen precursor, dehydroepiandrosterone (DHEA), on circulating androgen metabolites in women with the disease have major differences in design that make comparisons difficult. In addition to changes in sexual functioning, it is not known whether women with Addison's disease have altered fertility, although some evidence suggests reductions in fertility. This study was designed to investigate sexual functioning, peripheral androgen status, and birth rates in a population of women with Addison's disease. A total of 269 women who had been identified previously in a national survey of Addison's disease in Norway participated in a postal survey comprised of a Sexual Activity Questionnaire (SAQ) and a registration form containing information on the number of childbirths. Previously obtained blood samples were analyzed for levels of the circulating testosterone metabolite, 5α-androstane-3α,17β-diol-3-glucuronide; (3α-Diol-G), for comparison with levels in controls (114 female blood donors). SAQ scores were compared in Addison's patients (n = 148), and 2 control groups comprised of age-matched controls (n = 740) from the general population, and women who had been subjected to risk-reducing salpingo-oophorectomy (RRSO) (n = 234). The fertility rate was estimated using the standardized incidence ratio, which is the ratio between the number of observed births and that expected based on population statistics. The SAQ was completed by 65% (174/269) of the women with Addison's disease. Patients with Addison disease who were not receiving DHEA had significantly lower serum levels of 3α-Diol-G compared with the blood donors (mean, 0.53 vs. 2.2 ng/mL; P < 0.0001). In contrast, patients receiving DHEA had significantly higher 3α-Diol-G levels as compared with the blood donors (mean, 5.8 vs. 2.2 ng/mL; P < 0.002). Women with Addison's disease were as sexually active as controls, and experienced significantly higher pleasure and less discomfort. Compared with the RRSO women, Addison's patients reported lower pleasure but significantly less discomfort. Fertility was significantly impaired among patients with Addison's disease: the observed and expected numbers of births were 54 and 87.5, representing a standardized incidence ratio for birth of 0.69. These findings showing no reduction in sexual functioning among women with Addison's disease challenge the long-held view that androgens are important for sexual functioning in this population. Reasons for the reduction in fertility are unclear.