ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 S1.4

The trick is the combination

Wiebke Arlt


Birmingham University, Birmingham, UK.


This lecture will address the timely topic of androgen replacement in women, which according to consensus guidelines should only be carried out if adequate estrogenization is provided. Female androgens either derive from direct ovarian production or from peripheral conversion of the adrenal sex steroid precursor, dehydroepiandrosterone, towards active androgens. Therefore, loss of adrenal or ovarian function, caused by Addison’s disease or consequent to bilateral oophorectomy, results in severe androgen deficiency, clinically often associated with a loss of libido and energy. Importantly, physiological menopause per se does not cause androgen deficiency, as androgen synthesis in the ovaries may persist despite the decline in estrogen production. However, the definition of female androgen deficiency, as recently provided by 2002 Princeton consensus statement, is not precise enough and may lead to over-diagnosis due to the high prevalence of its diagnostic criteria: androgen levels below or within the lower quartile of the normal range and concurrent sexual dysfunction. On the other hand, the Endocrine Society USA guidelines published in 2006 and advising against all androgen replacement in women, is of no better help. Currenlty, androgen treatment should be reserved for women with severe androgen deficiency due to an established cause (mostly adrenal insufficiency, bilateral oophorectomy) and matching clinical signs and symptoms. Replacement options include transdermal testosterone administration or dehydroepiandrosterone treatment, both of which have been shown to result in significant improvements, in particular in libido and mood, while effects on body composition and muscular function are not well documented. It is important to keep in mind that the number of randomized controlled trials is still limited and we need to learn more about benefits and risks.

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