Are the Endocrine Society's Clinical Practice Guidelines on Androgen Therapy in Women Misguided? A Commentary

Abstract

The Endocrine Society Clinical Guidelines on Androgen Therapy in Women (henceforth referred to as the Guidelines) do not necessarily represent the opinion held by the many health-care professionals and clinicians who are specialized in the evaluation, diagnosis, and treatment of women's health in androgen insufficiency states. The recommendations provided in the published Guidelines are neither accurate nor complete. We disagree with the therapeutic nihilism promoted by these Guidelines. The members of the Guidelines Panel (henceforth referred to as the Panel), in their own disclaimer, stated that the Guidelines do not establish a standard of care. Based on data available in the contemporary literature, on the role of androgens in women's health, we provide in this commentary a point-by-point discussion of the arguments made by the Panel in arriving at their recommendations. It is our view that the Guidelines are not based on the preponderance of scientific evidence. Health-care professionals, physicians, and scientists often disagree when determining how best to address and manage new and emerging clinical issues. This is where we stand now as we endeavor to understand the role of androgens in a woman's health and welfare. Indeed, some basic facts are not in contention. All agree that dehydroepiandrosterone sulfate (DHEA-S) production from the adrenal gland begins during the preteen years, peaks in the mid 20s, then declines progressively over time. In contrast, ovarian androgen (i.e., testosterone) secretion commences at puberty, is sustained during a woman's peak reproductive years and declines as a woman ages, with a more rapid and steep decrease after surgical menopause. However, there are ample data to suggest that adrenal androgens play a role in the development of axillary and pubic hair, and that testosterone is critical for women's libido and sexual function. We take this opportunity to invite members of the Panel on Androgen Therapy in Women to discuss, clarify, comment, or rebut any of the points made in this Commentary. It is our goal to elevate this debate in order to provide women who are afflicted with androgen insufficiency and sexual disorders with the highest quality health care and to relieve their distress and suffering, as well as to improve their quality of life.

Restoring testosterone levels by adding dehydroepiandrosterone to a drospirenone containing combined oral contraceptive: I. Endocrine effects

“…T deficiency in women has been associated with a broad range of undesired effects [3,4], some of which, including mood disturbances and interference with sexual function, have been reported as side effects of COCs [5][6][7][8]. Normalizing total T and other androgen levels in women using a COC may be achieved by the co-administration of the natural human adrenal androgen dehydroepiandrosterone (DHEA), because it is orally bioavailable [9] and partially metabolized into T [10][11][12].…”

Sexual dysfunction in women: What can urologists contribute?

“…The Endocrine Society published clinical guidelines on androgen therapy in women, but a group of clinicians and researchers recognized that this document did not represent the opinion held by the many health care professionals, such as urologists [41], specializing in the evaluation, diagnosis, and treatment of women's health in androgen insuffi ciency states. Many believe that the recommendations provided by the Endocrine Society were neither accurate nor complete, and that based on data available in the contemporary literature the guidelines were not based on current scientifi c evidence.…”

Pharmacological Topics of Bone Metabolism: Recent Advances in Pharmacological Management of Osteoporosis

“…Although androgen replacement therapy can improve many clinical conditions including sarcopenia and osteoporosis, it is limited by the risk of prostate cancer in healthy men. Also in women, ovarian androgen secretion increases during woman's peak reproductive years and declines as a woman ages (9). However, it is so far not recommended to use testosterone generally because evidence of safety in long-term studies is lacking (10).…”