Androgens during the reproductive years, what's normal for women?

Marina A. Skiba, Robin J. Bell, Rakibul M. Islam, David J Handelsman, Reena Desai, Susan Davis

Research output: Contribution to journalArticleResearchpeer-review

Abstract

IMPORTANCE: Whether serum androgens identify women with 'androgen insufficiency' or 'androgen excess' is unresolved, as what constitutes normal remains uncertain. OBJECTIVE: To determine whether androgens, including 11-oxygenated C19 steroids, vary with age, menstrual cycle or body mass index (BMI) during the reproductive years. DESIGN AND SETTING: Cross-sectional study recruited from the eastern Australian states. PARTICIPANTS: 588 women, aged 18-39 years, not pregnant, breast-feeding or using systemic hormone therapy, with regular menstrual cycles and no prior diagnosis of polycystic ovarian syndrome. MAIN OUTCOME MEASURES: Sex steroids measured by liquid chromatography-tandem mass spectrometry. RESULTS: Testosterone and androstenedione concentrations were significantly higher during the menstrual cycle mid and luteal phases than the early follicular phase, with median (range) values across the cycle of 0.34 nmol/L (0.04-1.01) and 1.97 nmol/L (0.53-7.89) respectively. There were no cyclical variations in dehydroepiandrosterone (DHEA), 4.91 nmol/L (0.08-23.51), 11-ketoandrostenedione (11KA), 7.99 nmol/L (0.07-31.67) or 11-ketotestosterone (11KT), 1.27 nmol/L (0.03-7.61). Overweight women had lower median testosterone (p<0.05), DHEA (p<0.05), and 11KA (p<0.01) levels than normal weight women. All C19 steroids were significantly lower (p<0.01) in 35-39 year-olds compared with18-25 year-olds. The median ratios of 11KA: androstenedione (4.3:1) and 11KT: testosterone (3.9:1) did not change with age, after adjustment for BMI and cycle stage. CONCLUSIONS: This study demonstrates 11KA and 11KT are stable across the menstrual cycle and make major quantitative contributions to the circulating androgen pool. All C19 androgens decline with age before menopause, hence age-specific reference ranges are required for the interpretation of androgen levels in premenopausal women.
Original languageEnglish
Number of pages16
JournalJournal of Clinical Endocrinology and Metablism
DOIs
Publication statusAccepted/In press - 7 Aug 2019

Cite this

@article{cff58e85d168425882c462803f157d99,
title = "Androgens during the reproductive years, what's normal for women?",
abstract = "IMPORTANCE: Whether serum androgens identify women with 'androgen insufficiency' or 'androgen excess' is unresolved, as what constitutes normal remains uncertain. OBJECTIVE: To determine whether androgens, including 11-oxygenated C19 steroids, vary with age, menstrual cycle or body mass index (BMI) during the reproductive years. DESIGN AND SETTING: Cross-sectional study recruited from the eastern Australian states. PARTICIPANTS: 588 women, aged 18-39 years, not pregnant, breast-feeding or using systemic hormone therapy, with regular menstrual cycles and no prior diagnosis of polycystic ovarian syndrome. MAIN OUTCOME MEASURES: Sex steroids measured by liquid chromatography-tandem mass spectrometry. RESULTS: Testosterone and androstenedione concentrations were significantly higher during the menstrual cycle mid and luteal phases than the early follicular phase, with median (range) values across the cycle of 0.34 nmol/L (0.04-1.01) and 1.97 nmol/L (0.53-7.89) respectively. There were no cyclical variations in dehydroepiandrosterone (DHEA), 4.91 nmol/L (0.08-23.51), 11-ketoandrostenedione (11KA), 7.99 nmol/L (0.07-31.67) or 11-ketotestosterone (11KT), 1.27 nmol/L (0.03-7.61). Overweight women had lower median testosterone (p<0.05), DHEA (p<0.05), and 11KA (p<0.01) levels than normal weight women. All C19 steroids were significantly lower (p<0.01) in 35-39 year-olds compared with18-25 year-olds. The median ratios of 11KA: androstenedione (4.3:1) and 11KT: testosterone (3.9:1) did not change with age, after adjustment for BMI and cycle stage. CONCLUSIONS: This study demonstrates 11KA and 11KT are stable across the menstrual cycle and make major quantitative contributions to the circulating androgen pool. All C19 androgens decline with age before menopause, hence age-specific reference ranges are required for the interpretation of androgen levels in premenopausal women.",
author = "Skiba, {Marina A.} and Bell, {Robin J.} and Islam, {Rakibul M.} and Handelsman, {David J} and Reena Desai and Susan Davis",
year = "2019",
month = "8",
day = "7",
doi = "10.1210/jc.2019-01357",
language = "English",
journal = "Journal of Clinical Endocrinology and Metablism",
issn = "0021-972X",
publisher = "The Endocrine Society",

}

Androgens during the reproductive years, what's normal for women? / Skiba, Marina A.; Bell, Robin J.; Islam, Rakibul M.; Handelsman, David J; Desai, Reena; Davis, Susan.

In: Journal of Clinical Endocrinology and Metablism, 07.08.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Androgens during the reproductive years, what's normal for women?

AU - Skiba, Marina A.

AU - Bell, Robin J.

AU - Islam, Rakibul M.

AU - Handelsman, David J

AU - Desai, Reena

AU - Davis, Susan

PY - 2019/8/7

Y1 - 2019/8/7

N2 - IMPORTANCE: Whether serum androgens identify women with 'androgen insufficiency' or 'androgen excess' is unresolved, as what constitutes normal remains uncertain. OBJECTIVE: To determine whether androgens, including 11-oxygenated C19 steroids, vary with age, menstrual cycle or body mass index (BMI) during the reproductive years. DESIGN AND SETTING: Cross-sectional study recruited from the eastern Australian states. PARTICIPANTS: 588 women, aged 18-39 years, not pregnant, breast-feeding or using systemic hormone therapy, with regular menstrual cycles and no prior diagnosis of polycystic ovarian syndrome. MAIN OUTCOME MEASURES: Sex steroids measured by liquid chromatography-tandem mass spectrometry. RESULTS: Testosterone and androstenedione concentrations were significantly higher during the menstrual cycle mid and luteal phases than the early follicular phase, with median (range) values across the cycle of 0.34 nmol/L (0.04-1.01) and 1.97 nmol/L (0.53-7.89) respectively. There were no cyclical variations in dehydroepiandrosterone (DHEA), 4.91 nmol/L (0.08-23.51), 11-ketoandrostenedione (11KA), 7.99 nmol/L (0.07-31.67) or 11-ketotestosterone (11KT), 1.27 nmol/L (0.03-7.61). Overweight women had lower median testosterone (p<0.05), DHEA (p<0.05), and 11KA (p<0.01) levels than normal weight women. All C19 steroids were significantly lower (p<0.01) in 35-39 year-olds compared with18-25 year-olds. The median ratios of 11KA: androstenedione (4.3:1) and 11KT: testosterone (3.9:1) did not change with age, after adjustment for BMI and cycle stage. CONCLUSIONS: This study demonstrates 11KA and 11KT are stable across the menstrual cycle and make major quantitative contributions to the circulating androgen pool. All C19 androgens decline with age before menopause, hence age-specific reference ranges are required for the interpretation of androgen levels in premenopausal women.

AB - IMPORTANCE: Whether serum androgens identify women with 'androgen insufficiency' or 'androgen excess' is unresolved, as what constitutes normal remains uncertain. OBJECTIVE: To determine whether androgens, including 11-oxygenated C19 steroids, vary with age, menstrual cycle or body mass index (BMI) during the reproductive years. DESIGN AND SETTING: Cross-sectional study recruited from the eastern Australian states. PARTICIPANTS: 588 women, aged 18-39 years, not pregnant, breast-feeding or using systemic hormone therapy, with regular menstrual cycles and no prior diagnosis of polycystic ovarian syndrome. MAIN OUTCOME MEASURES: Sex steroids measured by liquid chromatography-tandem mass spectrometry. RESULTS: Testosterone and androstenedione concentrations were significantly higher during the menstrual cycle mid and luteal phases than the early follicular phase, with median (range) values across the cycle of 0.34 nmol/L (0.04-1.01) and 1.97 nmol/L (0.53-7.89) respectively. There were no cyclical variations in dehydroepiandrosterone (DHEA), 4.91 nmol/L (0.08-23.51), 11-ketoandrostenedione (11KA), 7.99 nmol/L (0.07-31.67) or 11-ketotestosterone (11KT), 1.27 nmol/L (0.03-7.61). Overweight women had lower median testosterone (p<0.05), DHEA (p<0.05), and 11KA (p<0.01) levels than normal weight women. All C19 steroids were significantly lower (p<0.01) in 35-39 year-olds compared with18-25 year-olds. The median ratios of 11KA: androstenedione (4.3:1) and 11KT: testosterone (3.9:1) did not change with age, after adjustment for BMI and cycle stage. CONCLUSIONS: This study demonstrates 11KA and 11KT are stable across the menstrual cycle and make major quantitative contributions to the circulating androgen pool. All C19 androgens decline with age before menopause, hence age-specific reference ranges are required for the interpretation of androgen levels in premenopausal women.

U2 - 10.1210/jc.2019-01357

DO - 10.1210/jc.2019-01357

M3 - Article

JO - Journal of Clinical Endocrinology and Metablism

JF - Journal of Clinical Endocrinology and Metablism

SN - 0021-972X

ER -