Prescribing testosterone and DHEA: The role of androgens in women

Abstract

E strogens are the principal sex hormones responsible for female reproductive maturation and sexual characteristics. However, androgens are also important for female sexual health and well-being. 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. 1 See related editorial, page 44Here we will discuss the physiologic roles of androgens as well as the indications and best-practice recommendations for androgen therapy in women. ■ ANDROGEN SYNTHESIS, PRODUCTION, AND MEASUREMENT IN WOMENThe biologically active androgens in women are dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione, 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. 2 DHEA-S, DHEA, and androstenedione are the main prohormones that are peripherally converted to the active androgens testosterone and dihydrotestosterone. 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. In target tissues, circulating testosterone is converted to dihydrotestosterone by 5-alpha-reductase and aromatized to estradiol .

The causal relationship of human blood metabolites with the components of Sarcopenia: a two-sample Mendelian randomization analysis

“…Hyodeoxycholate is a bile acid derivative, and a negative correlation between blood hyodeoxycholic acid and muscle uncoupling protein 3 gene was found, suggesting a potential impact on muscle function [ 34 ]. Androsterone sulfate is one metabolite of androgens, which may also be associated with the change of lean body mass and muscle mass [ 35 ]. This study found a negative association between androsterone sulfate and ALM, which further supports the potential link between androsterone sulfate and muscle function.…”

The Association Between Testosterone and Vascular Function in Reproductive-Aged Females With Chronic Kidney Disease

“…Testosterone is a sex hormone that contributes to sexual well-being in females, 24 although direct effects on cardiovascular health have also been described. 9 Although endogenous testosterone appears to have a positive effect on male cardiovascular health in a concentration-dependent fashion, 24 it is less clear what the cardiovascular implications of testosterone are in females. Studies in females with PCOS, who often have hyperandrogenism, demonstrate a relationship between increased testosterone levels and a poorer cardiovascular profile.…”

New evidence for the effect of type 2 diabetes and glycemic traits on testosterone levels: a two-sample Mendelian randomization study

“…In males, it is mainly responsible for promoting the development and maintenance of male sexual characteristics ( 26 ) and plays a significant role in the development and maintenance of the male skeletal system ( 27 ). It is responsible for the maintenance of sexual desire in females ( 28 ). In general, low testosterone is thought to be closely related to sexual dysfunction ( 29 ).…”