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Twenty women using oral contraceptives and complaining of impaired sexual function were compared with twenty women without sexual problems, matched for age and oral contraceptive. Whilst the sexual behaviour differed in the two groups, the plasma testosterone, androstenedione, oestradiol and SHBG concentrations were very similar. The total androgen levels were low in both groups. Plasma testosterone and oestradiol concentrations were correlated with measures of sexual interest in the no-problem group, but not in the problem group. Administration of exogenous androstenedione to women in the problem group, using a double blind cross-over comparison with a placebo, failed to improve their sexual function except in one case. The majority of women showed a rise in androgen and oestradiol between day 24 of one pill cycle and day 4 of the next. The possible behavioural indications of this pattern are discussed.

The behavioural effects of exogenous testosterone in men with marginally low circulating androgen levels were investigated. Four adult men with Klinefelter's syndrome, low normal testosterone levels and normal sexual activity and interest were given testosterone undecanoate (TU 160 mg daily by mouth; Organon International) and placebo using a double blind cross-over design. A modest increase in sexual interest was observed during TU administration compared to placebo, though there were no effects on self-reported mood or energy, or on erectile responsiveness in the laboratory. Increase in circulating hormone levels during TU administration was more marked for DHT than for testosterone. The possible implications of this are discussed.

The effects of androgen withdrawal and replacement were investigated in six hypergonadotrophic and six hypogonadotrophic men with hypogonadism. A double blind cross-over design was used comparing testosterone undecanoate (T.U., Organon International), 160 mg daily by mouth, with placebo. There was a significant effect of T.U. on all measures of sexual interest and behaviour. Sexual interest increased within the first week of T.U. administration, ejaculation usually returning within the second week. Behavioural responses were similar in the hyper- and hypogonadotrophic groups. The rise in plasma testosterone during T.U. administration was modest, not reaching the normal range in several cases. 5 alpha dihydrotestosterone rose more substantially. There was a significant fall in sex hormone binding globulin, a rise in oestradiol and no significant change in gonadotrophin concentrations during T.U. administration.