Will Androgens Help Menopausal Mood Symptoms?
Frederick R. Jelovsek MD
A recent set of symposium papers on the emerging role of estrogen and androgen therapy in the postmenopausal women was published in the Journal of Reproductive Medicine. There were several articles and from Vermeulen A:Plasma androgens in women. J Reprod Med 1998; 43:725-33I was able to extract a few general facts along with my personal interpretations:
Androgen Hormone in Women
| Observation | Implication |
|---|---|
| testosterone levels after removal of the ovaries are about 50% of the level of women who underwent natural menopause | women who have ovaries removed surgically need more testosterone supplementation than women who undergo natural menopause |
| estrogen levels are equally low in women who have had oophorectomy and women who have undergone natural menopause | the postmenopausal ovary doesn't manufacture estrogens of any significance |
| other androgens (androstendione, DHEA) made by the adrenal gland decrease slowly with age so that in women over age 70 they are 20% of the levels at age 20 | androgen decline is an aging process and adds to acute changes at menopause or surgical ovarian removal |
| androgens are naturally converted to estrogens by the body and the rate of conversion increases with age | the body uses natural or supplemented androgens as a source of estrogen |
| in postmenopausal women who have pain with sexual relations, estrogen improves sexual satisfaction, but in postmenopausal women without pain during sex, estrogens do not improve sexual satisfaction or sexual functioning | if vaginal dryness is present, estrogens will help sexual functioning, probably by reducing pain |
| androgen supplementation after menopause has been shown to have a positive affect on sexual desire (libido), arousal, fantasies, satisfaction, pleasure, orgasm and relevancy | androgen supplementation should be added to estrogen replacement in any women who has any symptoms or complaints of decreased sexual functioning or overall wellbeing |
| in order to get sexual mood benefits from androgens, blood levels need to be restored to upper normal levels for premenopausal women | through supplementation, levels of testosterone 1.4- 1.6 nmol/L (40-50 ng/dL) and DHEA -S -- 6-8umol/L (200-300ug/dL) are desireable if there are no signs of androgen excess (acne, increased hair growth, voice deepening, and temporal balding) |
Another basic tenet came from these articles. It is that relief of any of the symptoms such as hot flashes, sweats, sexual libido, vagianl dryness, is incomplete with any hormonal regimen. Some women, 25-35%, will continue to have major symptoms and most women who get relief will not get total relief, only about 2/3's of their symptoms.
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