Androgen Co-therapy In Menopause

Abstract

Menopause is associated with various hormonal changes, including androgen deficiency. This review discusses the place of androgen therapy in the management of menopause, including the pitfalls in diagnosis, the confusion surrounding androgen prescription, and the reasons behind this controversy. HORMONAL CHANGES IN MENOPAUSE Menopause is associated with a variety of endocrine changes (1). These lead to a reduction in sexuality and well-being (2). The changes include: Decline in growth hormone. This begins prior to 1. ovarian failure, and is a normal part of life. It is accelerated during peri-menopause, and itself may accelerate ovarian failure. Fibrosis of thyroid gland, and a decline in serum 2. T3 of 25% to 40%, though most post menopausal women remain clinically euthyroid. Reduction in estrogen levels, with the predominant 3. estrogen being the less potent estrone, derived from peripheral conversion of androstenedione in the liver, fat and some hypothalamic nuclei. Fall in serum DHEA and DHEAS levels, which are 4. greater in women than men, and may be due to the relative estrogen deprivation. Decline in androgen production. The production of 5. the predominant androgen, androstenedione, declines from 1500 to 800pg/ml, with only 20% being contributed by the ovary in post menopausal women. Post menopausal testosterone levels are also lower 6. than those in premenopausal women, with the decline beginning around age 30.Testosterone levels at age 40 are half those at age 21. At menopause, a 15% decline occurs in testosterone and androstenedione. Dihydrotestosterone, the most potent of 7. endogenous androgens, decreases by 44% between the third and eighth decade. This decline is associated with reductions in metabolic concentrations.