Clinical review 82: Androgens and the postmenopausal woman.

HE PREDOMINANT emphasis in the study of hormones in post-menopausal women has been accorded to estrogens and progestins, with lesser attention being given to androgens and the issue of androgen replacement. This is perhaps because androgens are traditionally thought of as male hormones, and the impact of excessive androgen activity in women, for example as in hirsutism, receives more attention than the activity of androgens in normal female physiology and the sequelae of androgen deficiency. There is an increasing awareness of the significant activity of endogenous androgens in women. Women with androgen deficiency may experience a variety of physical symptoms secondary to their androgen depletion as well as psychological changes that affect their quality of life (1). Androgen physiology in the premenopausal years Androgens are produced both by the ovaries and the adrenals, which synthesize androstenedione (A), testosterone (T), and dehydroepiandrosterone (DHEA), with the adrenals also producing DHEA sulfate (DHEA-S). At least 50% of circulating T is produced by peripheral conversion of the preandrogens to T, with A being the main precursor (2). In regularly ovulating women, there is a small, but significant, cyclicity of plasma A and T, with increases in the circulating mean levels of both of these hormones during the middle third of the menstrual cycle (3) and a second rise in A prodiction by the corpus luteum occuriing in the late luteal phase. Ovarian androaen is secreted bv thecal cells under the controlbf LH.