ANDROGEN THERAPY AND PRODUCTION IN WOMEN

Androgen deficiency in women is a topic far less discussed in comparison to their male counterparts.  Androgens are hormones that contribute to growth and reproduction in both men and women.  They are usually thought of as male hormones, but the female body also naturally produces a small amount of androgens.

Androgen production in women tapers off with increasing age.  By the time a woman is 40 years old, her androgen levels are about half of what they were when she was 20.

Some researchers believe that androgen deficiency in women can cause symptoms that include lethargy and loss of sexual interest.  Other researchers believe that the condition, if it exists, is too poorly understood to treat safely.

Symptoms of Androgen Deficiency
Some of the suggested symptoms of androgen deficiency in women may include:

• lethargy
• loss of muscle mass and strength
• loss of libido
• lack of motivation
• low emotional state
• lowered mood

Androgens are hormones; Hormones are chemical messengers that communicate with tissues in the body to bring about many different changes.  Androgens are usually thought of as male hormones, but the female body naturally produces a small amount of androgens too– on average, about 1/10 to 1/2 of the amount produced by the male body.

The most common androgen is testosterone.  Dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS) and androstenedione are also referred to by some as androgens, although they are actually converted to testosterone and so may be called ‘pre-androgens’.

The ovaries, adrenal glands, fat cells and skin cells make the female body’s supply of androgens.  The ovaries convert testosterone into the female hormone oestrogen.

Causes of Androgen Deficiency in Women
Some of the possible causes of androgen deficiency in women include:

• aging- a drop in testosterone naturally occurs in all women over time from about the late teenage years
• oophorectomy- the surgical removal of the ovaries
• chemical oophorectomy- ovarian failure caused by certain drugs called gonadotropin-releasing hormone antagonists, chemotherapy or radiotherapy
• oestrogen therapy- the combined oral contraceptive pill or oestrogen replacement therapy for managing the symptoms of menopause.
• hypothalamic amenorrhoea- the loss of menstrual periods in a woman of reproductive age, which could be caused by various factors such as stress, extreme weight loss or extreme exercise. This again lowers the amount of the androgen-stimulating hormone
• hyperprolactinaemia- overproduction of the pituitary hormone prolactin
• premature ovarian failure- early menopause (before the age of 40), with various causes
• adrenal insufficiency- primary or secondary to deficiency of pituitary adrenocorticotropic hormone (ACTH)
• hypopituitarism- a rare disorder of the pituitary gland

The risk of side effects depends on many factors such as the treatment method, the dosage and the duration of therapy. Some of the known side effects of excessive testosterone replacement therapy in women include:

• masculine physical characteristics, such as facial hair, acne, male-pattern balding, deepened voice– These are extremely unlikely if dosage is monitored appropriately.
• aggressive mood swings
• sleep apnoea
• hirsutism – excess hair growth
• headache

Testosterone replacement therapy should not be given to women who:

• are pregnant or planning to become pregnant
• are of reproductive age, sexually active, but not using adequate contraceptive measures (testosterone can cause serious abnormalities to develop in an unborn baby and termination of pregnancy is likely to be advised if a woman becomes pregnant while using testosterone)
• are breastfeeding
• suffer from acne
• have hirsutism (excessive body or facial hair)
• suffer from alopecia (hair loss)
• have steroid-dependent cancers

A full medical check-up is important.  The symptoms of androgen deficiency are similar to those of many other conditions such as hypothyroidism (underactive thyroid), iron deficiency anaemia, autoimmune disease and depression.  Your doctor may need to assess you for these conditions.