ANDROGEN REPLACEMENT THERAPY IN POSTMENOPAUSE

Abstract

BACKGROUND Androgen administration for hormonal replacement therapy (HRT) in postmenopausalwomen has recently been involved in many panels and investigations. The objective forthe introduction of androgen replacement in postmenopausal women was the opinionthat impaired libido and well-being in women with normal estrogen concentration (withHRT or in reproductive period) is the consequence of androgen deficiency.Physiology of female androgen production in women emphasizes the production ofdehydroepiandrosteron (DHEA) as crucial precursor of human sex steroid biosynthesistogether with its sulphate ester (DHEAS). DHEA and DHEAS do not have androgen activityunless they are converted to testosterone and dihydrotestosterone, which can both bind and activate androgen receptor. The ability of ovarian theca cells to synthesize androgenspersists also after menopause, the fact being illustrated by finding that bilateral oophorectomy in postmenopausal women leads to a significant decrease in circulating levels ofandrogen. The definition of female androgen deficiency syndrom (FADS) was presentedas Princeton’s consensus meeting three criteria: impaired libido and well-being with normal estrogen values (established estrogen replacement) and serum androgen concentrations below or within the lower quartile of the female normal range. The criticism of Princeton’s consensus is focused mainly on loose definition of impaired libido. The similar critical estimation followed new diagnostic term »hypoactive sexual desire disorder« (HSDD).The task force of endocrine societies from Canada, USA and Australia has provided recentguidelines for therapeutic use of androgens in women. They recommended againstmaking a diagnosis of androgen deficiency in women because this clinical syndrome hasnot been defined properly. In spite of some data of clinical effectiveness of androgen replacement in selected population of women, there are no adequate indications andevidence of safety in long term administration. They recommend well designed and focused studies of androgen action in the population of women after surgical castration, inwomen with hypopituitarrism and adrenal insufficiency. CONCLUSIONS Scientific studies and clinical experiences have not provided until now the answers to thequestion: »Whom to treat, when, why and for how long should androgens be used for HRTin postmenopausal women?«