Marked decrease of the male hormone testosterone
The effects of sex steroids on the cardiovascular system are not fully understood.
#Marked decrease of the male hormone testosterone free#
Conditions that increase or decrease SHBG inversely affect circulating levels of free (active) testosterone ( Table 1). Testing of total testosterone levels also measures inactive testosterone, which is bound to sex hormone-binding globulin (SHBG), a liver-synthesized protein with a high affinity for sex steroids. In circulation, active testosterone is free or bound to albumin. 4 Ten years after the onset of menopause, circulating testosterone and androstenedione levels are half of perimenopausal levels. 4, 5 Consequently, women who have undergone bilateral oophorectomy have a marked decrease in circulating testosterone levels, though serum concentrations of DHEA and androstenedione remain stable due to adrenal compensation. 3 Menopause is not associated with a rapid decline in androgen production the postmenopausal ovary is hormonally active and accounts for 40% to 50% of postmenopausal testosterone production. In target tissues, circulating testosterone is converted to dihydrotestosterone by 5-alpha-reductase and aromatized to estradiol.Īndrogen levels decline with age throughout a woman’s life, starting in her mid-30s. DHEA-S is almost exclusively produced in the adrenal glands, whereas DHEA, androstenedione, and testosterone are produced in the adrenal glands and ovaries and by peripheral conversion. 2 DHEA-S, DHEA, and androstenedione are the main prohormones that are peripherally converted to the active androgens testosterone and dihydrotestosterone. In women, roughly 25% of androgen production occurs in the adrenal glands, 25% occurs in the ovaries, and the rest occurs peripherally. The biologically active androgens in women are dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione, testosterone, and dihydrotestosterone. Here we will discuss the physiologic roles of androgens as well as the indications and best-practice recommendations for androgen therapy in women.ĪNDROGEN SYNTHESIS, PRODUCTION, AND MEASUREMENT IN WOMEN
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1 The physiologic effects of androgens are in part due to their role as precursors for estrogen synthesis, but these hormones also have independent effects on female reproductive tissues, mood, cognition, breasts, bones, muscles, vasculature, and other systems.
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However, androgens are also important for female sexual health and well-being. Decisions to continue treatment are based on clinical response hormone levels do not correlate with symptom burden, and testing is intended only to ensure safe delivery of treatment.Ĭlinicians should avoid diagnosing female androgen deficiency on the basis of hormonal testing, as the syndrome is not well defined, and interpreting androgen levels and their physiologic effects is complex.Įstrogens are the principal sex hormones responsible for female reproductive maturation and sexual characteristics. When treatment is offered, transdermal preparations are preferred, and testosterone levels should be checked before and during treatment to ensure physiologic dosing.
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Several randomized controlled trials have established the short-term safety and efficacy of prescribed testosterone in women when doses approximate physiologic levels. Currently, the only evidenced-based indication for testosterone therapy in women is for treating hypoactive sexual desire disorder in postmenopausal women.