Endocrine Abstracts

Background: Ovarian and adrenal aging leads to a progressive decline in androgens levels and deleterious effects on the quality of life. Despite this, specific hormone replacement is not routinely recommended in the management of women with a physiological or pathological decline in their production, mainly due to the lack of long-term follow-up safety data.

Aim of the study: To evaluate and summarize the existing data about hormonal profile changes in menopausal women receiving androgen replacement treatments, considering all available androgens formulation and regimens.

Methods: The literature search was conducted to identifyall randomized clinical trials and case-control studies evaluating hormonal effects of exogenous administration of any molecule with androgenic action in post-menopausal women published in English language until May 2018 (PROSPERO registration ID: CRD42018099414).

Results: Fifty-threepapers were included in the analysis, accounting for 83 trials. Androgen administration increases testosterone serum levels (2159 treated women vs 2246 controls, P < 0.001), regardless of the molecule used. Similarly, an increase of dehydroepiandrosterone (DHEA) and DHEA-sulfate serum levels was observed (P < 0.001 and P < 0.001, respectively), with a concomitant reduction in sex hormone binding globulin (SHBG) levels (P < 0.001). However, the estrone (E1) and estradiol (E2) increase is evident only when DHEA is administered (P < 0.001 and P < 0.001, respectively), and not when testosterone (P = 0.120 and P = 0.690, respectively) or androstenedione (P = 0.400 and P = 0.540, respectively) where chosen.

Conclusion: Whatever androgen formulation we choose in postmenopausal women, the final result is a rise in testosterone serum levels. However, DHEA regimen shows a combined estrogenic activity. This peculiar action is crucial when choosing the best possible treatment for each patient individually taking into consideration if potential benefits outweigh the risks.