Endocrine Abstracts

Dehydroepiandrosterone (DHEA), the major product of the adrenal zona reticularis, is a crucial sex steroid precursor. Suppression of DHEA production in females, e.g. by exogenous glucocorticoids, results in significant overall androgen deficiency. The ovaries contribute to some extent to circulating female androgens, mainly by converting the precursor steroid DHEA to androgens directly binding and activating the androgen receptor, testosterone and dihydrotestosterone. Loss of adrenal function, e.g. in adrenal insufficiency or due to chronic glucocorticoid treatment, results in pronounced androgen deficiency. Similarly, women undergoing bilateral oophorectomy often suffer a significant decrease in circulating androgens. Seminal studies in both these groups have provided the data that form the basis of our current recommendations for androgen therapy in women. However, it is important to stress that physiological menopause per se does not cause androgen deficiency, as androgen synthesis in the ovaries may persist postmenopausally despite declining estrogen production. The definition of female androgen deficiency in the 2002 Princeton consensus statement, androgen levels below or within the lower quartile of the normal range and concurrent sexual dysfunction, is not precise enough and may lead to over-diagnosis. On the other hand, the Endocrine Society USA guidelines published in 2006 and advising against all androgen replacement in women, is no better help for the concerned clinician. Androgen treatment should be considered in women with severe androgen deficiency due to an established cause such as adrenal insufficiency or bilateral oophorectomy and matching clinical symptoms. Replacement options include transdermal testosterone or oral DHEA, both of which have been shown to result in significant improvements in libido and mood and also of body composition and bone mineral density. It is important to keep in mind that the number of randomized controlled trials is still limited and we need to learn more about the respective benefit and risk ratios.