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Published on: August 13, 2019
Hormonal profile of menopausal women receiving androgen replacement therapy: a meta-analysis
L Marina1, A S Sojat1, E Maseroli2
1Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Purpose:
Ovarian and adrenal aging leads to a progressive decline in androgen levels and deleterious effects on the quality of life. Despite this, specific replacement is not routinely recommended in the management of women with a physiological or pathological decline in their production, mainly due to the lack of long-term follow-up safety data. The purpose of this paper was to meta-analyze and summarize the existing data about hormonal profile changes in menopausal women receiving androgen replacement treatments. Full-text articles published through May 30, 2018 were found via MEDLINE and Embase and selected according to the strict inclusion criteria.
Methods:
Randomized clinical trials and case-control studies were enrolled. Studies not reporting steroid serum levels or not providing a control group were excluded from the analysis. Studies enrolling women with genetic defects or severe chronic systemic diseases were excluded. 113 papers fulfilled the inclusion criteria and 56 papers were included in the analysis. Desired data were compiled and extracted by independent observers.
Results:
Androgen administration increases E1, E2, testosterone, DHEA and DHEAS serum levels, and reduces SHBG. However, the E1 and E2 increase is evident only when DHEA is administered.
Conclusions:
Whatever androgen formulation we choose in postmenopausal women, the end result is a rise in testosterone serum levels. However, DHEA regimen is also associated with an increased estrogenic availability. This might be crucial when choosing the best possible treatment for each patient individually taking into consideration if potential benefits outweigh the risks.
Insights
Androgen replacement therapy in postmenopausal women increases testosterone levels. Dehydroepiandrosterone (DHEA) specifically boosts estrogen levels, offering personalized treatment options.
Area of Science:
- Endocrinology
- Menopause Research
- Hormone Replacement Therapy
Background:
- Aging leads to decreased androgen levels, impacting women's quality of life.
- Androgen replacement is not standard due to limited long-term safety data.
Purpose of the Study:
- To meta-analyze hormonal profile changes in menopausal women undergoing androgen replacement.
- To summarize existing data on androgen therapy's effects.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials and case-control studies.
- Inclusion criteria focused on studies reporting steroid serum levels and control groups.
- Excluded studies on women with genetic defects or severe chronic diseases.
Main Results:
- Androgen therapy increased serum levels of estrone (E1), estradiol (E2), testosterone, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEAS).
- Reduced sex hormone-binding globulin (SHBG) levels were observed.
- Increased E1 and E2 levels were specifically linked to DHEA administration.
Conclusions:
- All androgen formulations elevate testosterone in postmenopausal women.
- DHEA treatment also enhances estrogen availability, suggesting individualized treatment approaches.
- Careful consideration of potential benefits versus risks is crucial for patient-specific therapy.
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