Androgen therapy for postmenopausal women

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Abstract

What is androgen therapy and why is it sometimes prescribed? Traditionally, the term ?androgens? refers to a group of 19-carbon steroid hormones that are associated with maleness and the induction of male secondary sexual characteristics. This is as outdated as the concept of estrogen being only a female hormone. The major androgens circulate in concentrations greater than those of the estrogens in healthy women and androgens have a critical role in female physiology. Testosterone is the main androgen in women, with its more potent metabolite, dihydrotestosterone (DHT), being important at a cellular level. The steroids, androstenedione and dehydroepiandrosterone (DHEA), are classified as pre-androgens, although each exhibits very weak binding to the androgen receptor. Androstenedione and DHEA are produced by both the ovaries and the adrenals, whereas DHEA sulfate (DHEA-S) is almost exclusively a product of the adrenal glands. Dehydroepiandrosterone is a precursor for androstenedione production, which in turn can be converted to testosterone or estrone. Androgen therapy in clinical practice refers to testosterone therapy, although DHEA is sometimes included under this heading. Androstenedione has been used as a body-building supplement, but its use as such is banned by the Food and Drug Administration of the USA and international sporting bodies because of safety concerns. There is widespread prescription of DHEA as androgen therapy for women. Clinical trials have consistently shown that systemic DHEA therapy is not effective for the treatment of female sexual dysfunction (FSD) in women with either normal or impaired adrenal function, and should not be prescribed for this purpose [1]. Dehydroepiandrosterone does not improve mood or cognitive function in healthy women. Dehydroepiandrosterone may improve the health-related quality of life and mood in women with adrenal insufficiency, although these effects have been described as trivial [2]. There are preliminary data that daily intravaginal DHEA may alleviate vulvo-vaginal atrophy, but this requires confirmation in larger studies. Tibolone is a synthetic compound that is used as a postmenopausal hormone therapy. It is metabolized in the gut and target tissues to isomers that exhibit estrogenic, progestogenic and androgenic actions. It therefore alleviates vasomotor symptoms and urogenital atrophy but does not activate the endometrium, and so does not cause vaginal bleeding.
Original languageEnglish
Title of host publicationManaging the Menopause
Subtitle of host publication21st Century Solutions
EditorsNick Panay, Paula Briggs, Gab Kovacs
Place of PublicationCambridge UK
PublisherCambridge University Press
Pages136-141
Number of pages6
ISBN (Print)978-1-107-45182-7
DOIs
Publication statusPublished - 2015

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