Androgen; Key Q&A

Androgen; Key Q&A

Why do women need androgens?

Androgens were formerly thought of as the “male sex hormones,” but now we know that they have an important role in women as well, even though women’s levels are much lower than men’s. In women, androgens have more than 200 cellular actions, including helping maintain a healthy sex drive, preventing fatigue and contributing to a woman’s overall sense of well-being. They also prevent bone loss and bone disease and play a role in the formation of estrogen.

What happens if my body does not produce enough androgens?

Your sex drive, or libido, may flag, and you may experience fatigue and a decline in your overall sense of well-being. Low androgen levels can also contribute to bone loss and bone disease.

What happens if my body produces too much androgen?

Androgen levels in women peak during her twenties. Then a decline in daily production begins that continues throughout a woman’s life. The only time a sudden drop off in androgen levels occurs is in women who have had their ovaries removed (about half of all androgens are produced in a woman’s adrenal glands, and half in her ovaries.) By the time a woman reaches menopause, blood androgen levels are about half of what they were at her peak.

As your androgen levels rise, you may experience such “virilizing” effects as facial hair growth, androgenic alopecia (thinning of the hair on your head), acne and oily skin. In addition to these cosmetic effects, if your androgen excess is related to polycystic ovary syndrome (PCOS), you may experience irregular periods that indicate you are not ovulating. Hyperandrogenism or PCOS can also put you at risk of heart disease, glucose intolerance and diabetes.

Is medication available to treat hypoandrogenism?

Yes, oral methyltestosterone is available in combination with esterified estrogens by prescription (Estratest). DHEA, a hormone that is converted into an androgen, is available without a prescription in the U.S., but is not FDA regulated. Therefore, monitoring of serum DHEA levels and side effects is essential in anyone taking this hormone. Some compounding pharmacies may also be able to provide vulval creams for more targeted delivery. Remember, efficacy and safety studies are lacking in non-FDA regulated products.

What are the side effects of those medications?

If the dosage is too high, you may experience symptoms of hyperandrogenism, such as facial hair growth, acne or oily skin, or a deepening of your voice. Androgen supplements may also negatively affect cholesterol levels (thus increasing your risk of heart disease). If you notice any side effects, tell your health care professional at once. A lower dose can usually resolve side effects, and stopping taking it may reverse them altogether.

I clearly have the symptoms of hypoandrogenism, so why won’t my health care professional prescribe supplements?

The symptoms of low androgen levels — reduced libido and energy, sense of malaise — mirror those of many other disorders. A health care professional should be cautious and rule out other common problems before considering testosterone replacement, particularly if you are under 40 and have no other condition that would cause hypoandrogenism, such as ovarian failure. A health care professional may want to explore your health history, and test for conditions like hypothyroidism and iron deficiency.

Is medication available to treat hyperandrogenism?

Yes, a variety of medications may help reduce testosterone or prevent its conversion into an active form. They include oral birth control pills (with norgestimate or norgestrel); spironolactone (Aldactone or Spironol), a diuretic; and flutamide (Eulexin) and finasteride (Propecia), which are used in men to treat prostate growth and cancer, and male pattern baldness.

What precautions should I take with those medications?

You should adhere to a birth control regimen with added vigilance if a health care professional prescribes an androgen-inhibiting drug. These medications can cause birth defects if taken while pregnant. Talk to a health care professional about other possible side effects. See the oral contraceptives topic on this site for a complete discussion of the side effects of birth control pills.

What’s the difference between hyperandrogenism and polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome is a hyperandrogenic disorder; it is distinguished by irregular or absent periods, which indicate a woman may not be ovulating.

References

Effects of Estrogen plus Progestin on Health-Related Quality of Life. J. Hays et al. NEJM, May 8,2003; Vol. 348, No. 19.

FDA Approves Lower Dose of Prempro, a Combination Estrogen and Progestin Drug for Postmenopausal Women. FDA News (press release). March 13, 2003. http://www.fda.gov

Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33.

FDA Orders Warning on all Estrogen Labels. New York Times. Jan. 9, 2003, http://www.webprowire.com.

FDA Approves new Labels for Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women Following Review of Women’s Health Initiative Data. FDA Talk Paper. Jan. 8, 2003

Grady D, Herrington D, Bittner V, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 1. Cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:49-57.

Hulley S, Furberg C, Barrett-Connor E, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 2. Non-cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:58-66.

Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288:321-333.

“Estrogen Plus Progestin Study Stopped Due to Increased Breast Cancer Risk, Lack of Overall Benefit.” National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov. Updated July 9, 2002; accessed Sept. 2003.

Lacey, James V., et al. “Menopausal Hormone Replacement Therapy and Risk of Ovarian Cancer.” JAMA 2002. Vol. 288:334-341.368-369.

Journal of the American Medical Association. Friedrich MJ. “Can Male Hormones Really Help Women?” May 24/31, 2000 — Vol. 283, No. 20. http://jama.ama-assn.org

The Journal of Gender-Specific Medicine. Davis S. “Androgens and Female Sexuality.” JGSM. Vol. 3, No. 1. Jan/Feb 2000. http://www.mmhc.com

The Medical Journal of Australia. Davis S. MJA 1999; 170: 545-69. “Androgen treatment in women.” http://www.mja.com.au

U.S. Pharmacist. Cutler S, Cutler J, et al. “Testosterone Replacement in Women.” U.S. Pharmacist. Sept. 2000. http://www.uspharmacist.com

American Association of Clinical Endocrinologists. “Medical Guidelines For Clinical Practice For the Diagnosis and Treatment of Hyperandrogenic Disorders.” Issued 2001. http://www.aace.com

The American College of Obstetricians and Gynecologists. “Androgen Replacement No Panacea for Women’s Libido” News Release. Oct. 2000. http://www.acog.org

The Journal of Clinical Endocrinology & Metabolism. Miller K. “Androgen Deficiency in Women” Vol. 86, No. 6, June 2001.

Solvay Pharmaceuticals — Estratest Fact Sheet. Accessed August 2001. http://www.solvaypharmaceuticals-us.com

Estratest information from Solvay Pharmaceuticals. November 2005. Available at: http://www.solvaypharmaceuticals-us.com. Accessed November 2005.

Buster JE, Kingsberg SA, Aguirre O, Brown C, Breaux JG, Buch A, et al. Testosterone patch for low sexual desire in surgically menopausal women: a randomized trial. Obstet Gynecol 2005;105:944-52.

Keywords: androgen, androgen replacement, androgens, androgen levels, low androgen levels , sex drive, polycystic ovary syndrome, hyperandrogenism, birth control, hypoandrogenism, in women, side effects

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