Management of the androgen-deficient woman

Active androgens in women either derive from direct ovarian production or from peripheral synthesis via downstream conversion of the adrenal sex steroid precursor dehydroepiandrosterone (DHEA). Significant androgen deficiency is present in adrenal and/or gonadal failure (e.g., due to Addison's disease, hypopituitarism, premature ovarian failure, or chronic glucocorticoid therapy). Androgen replacement in these women may result in significant improvements with regard to libido, mood, and bone mineral density. However, choosing both a convenient and efficient mode of androgen administration currently remains a challenge. Androgen levels do not necessarily change during physiological menopause, and the so-called female androgen deficiency syndrome (FADS) still awaits precise definition. Thus, androgen replacement should not be routinely considered in postmenopausal women but should be reserved for women with established androgen deficiency and related symptoms.