high testosterone levels. women with pcos actually experience an improvement in sexual desire following treatment of their condition, likely due improved psychological functioning (e.g., body image). sexual desire is not decreased in women with complete androgen insensitivity syndrome (cais) relative to unaffected women in spite of a completely non-functional androgen receptor. systematic reviews and meta-analyses of research on variation during the menstrual cycle of women's sexual activity with partners and the effects of the use of the combined oral contraceptive pill (cocp) by women on their sexual desire show that sexual desire is self-reported to be unchanged in most women taking cocps, but also conclude that the effects of cocps on women's sexual desire is not well-studied and that women experience increased sexual activity with partners in the last third of the follicular phase of the menstrual cycle and at ovulation (when levels of endogenous estradiol and luteinizing hormones are heightened) as compared with other phases. almost all combined birth control pills contain the potently liver-active estrogen ethinylestradiol, and the typical doses of ethinylestradiol present in combined birth control pills increase sex hormone-binding globulin (shbg) levels by 2- to 4-fold and consequently decrease free testosterone levels by 40 to 80%. cross-sectional research has shown that shbg is inversely correlated with sexual desire in premenopausal women. there are conflicting reports on the effects of combined birth control pills on sexual function in women. progestogen-only birth control, such as with depot medroxyprogesterone acetate or the etonogestrel birth control implant, has shown mixed effects on sexual desire and function. androgen receptor antagonists such as flutamide and bicalutamide cause little to no decrease in sexual desire in women. low dosages of testosterone that result in physiological levels of testosterone (< 50 ng/dl) do not increase sexual desire in women. high dosages of testosterone that result in supraphysiological levels of testosterone (> 50 ng/dl) significantly increase sexual desire in women, with levels of testosterone of 80 to 150 ng/dl "slightly" increasing sexual desire. further higher dosages of testosterone may result in greater effects on sexual desire in women. high dosages of testosterone (with levels of > 50 ng/dl) have a risk of masculinization (e.g., acne, hair growth, voice changes) with long-term therapy in women. high dosages of testosterone but not low dosages of testosterone enhance the effects of low dosages of estrogens on sexual desire. tibolone, a combined estrogen, progestin, and androgen, may increase sex drive to a greater extent than standard estrogen–progestogen therapy in postmenopausal women. transgender individuals testosterone therapy increases sexual desire and arousal in transgender men. estradiol and antiandrogen therapy increase sexual desire and arousal in transgender women after a temporary decrease.