Androgens in Women With Anorexia Nervosa and Normal-Weight Women With Hypothalamic Amenorrhea

Abstract

Both anorexia nervosa and normal-weight hypothalamic amenorrhea feature hypogonadism and hypercortisolemia, but it is not clear whether these abnormalities reduce levels of adrenal and/or ovarian androgens or androgen precursors, or whether relative androgen deficiency results in abnormal bone mineral density (BMD) and body composition. The investigators hypothesized that levels of androgens and the preandrogen hormone dehydroepiandrosterone sulfate (DHEAS) are reduced in women with anorexia and also in normal-body-weight women with hypothalamic amenorrhea, and that further reductions would be associated with oral contraceptive use in anorexic women. Levels of total and free testosterone and DHEAS were estimated in 137 women with anorexia nervosa who were not on oral contraception, 32 others who were, 21 women of normal body weight who had hypothalamic amenorrhea, and 27 healthy control women of reproductive age. Levels of endogenous total and free testosterone-but not DHEAS-were lower in anorexic women than in control subjects. More marked reductions in both free testosterone and DHEAS were observed in anorexic women taking oral contraceptives. In contrast, normal-body-weight women with hypothalamic amenorrhea had normal levels of androgens and DHEAS. At most skeletal sites evaluated, lower levels of free and total testosterone as well as DHEAS correlated with lower BMD. In addition, levels of free testosterone correlated positively with fat-free mass. Both total and free testosterone levels were associated with levels of sex-hormone-binding globulin (SHBG), and mean levels of SHBG were higher in those anorexic women who were taking oral contraceptives. Interventional studies will be needed to learn whether oral contraceptive use, associated with reduced levels of endogenous androgens, has adverse skeletal effects on women with anorexia nervosa. Marked reductions in DHEAS were observed in the anorexic women receiving oral contraceptives.