Background: Oral contraceptive agents (OCs) have been the preferred method of birth control because of their high rate of effectiveness and personal control over fertility. Despite their benefits, OC use has been associated with sexual dysfunction and androgen insufficiency. OCs are known to decrease serum testosterone levels by decreasing ovarian production of testosterone and by increasing production of sex hormone-binding globulin (SHBG) from the liver. It has been assumed that these changes are reversible after discontinuation of OC use. We have anecdotally observed, however, that SHBG levels can remain elevated for prolonged periods. Therefore, we investigated the natural history of SHBG levels after discontinuation of OC use.
Methods: This was a retrospective, institutional review board-approved study of 124 premenopausal women with female sexual dysfunction who either were taking OCs (“users”; N=62; mean age, 37 years) or had discontinued the use of OCs at some point during their treatment of sexual dysfunction (“dc users”; N=39; mean age, 33 years). Serving as a control group were 23 women who had never taken OCs (“never -users”; mean age, 36 years). We measured and compared SBHG values in all three groups at baseline and at certain time intervals after discontinuing the use of OCs (at baseline, 49 -120 days and >120 days). P-values < 0.05 were considered significant.
Results: SHBG values in the OC user group were 4 times higher than those in the never-user group (mean 160±7 nmol/l vs.41 ±4; P<0.0001). Despite a decrease in SHBG values after discontinuation of OC use, SHBG levels remained elevated in comparison with those in the control group (N=26; P<0.0001 for 49-120 days; P=0.0032 for >120 days)
Conclusion: Oral contraceptives create a hypoandrogenic environment. SHBG induction by OCs may not be completely reversible after discontinuation of OC use.

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