Androgens in postmenopausal women TOG 2022 Flashcards
How much more testosterone do women produce than oestrogen
3-4 x more - most quantitively most prevalent active sex hormone Hsteroid in women
Diagram showing pre-menopausal production of androgen
Explain the androgen production from the ovaries premenopause
The theca cells produces testosterone and androtestosterone, which either circulate or converted to oestrogens by the granulose cells.
When during the menstrual cycle is testosterone production from the ovaries highest, and when during the day?
Highest mid cycle and remain high during luteal phase.
Highest in morning.
Which precursors are most made by the adrenal glands?
Adrenals make DHEA-S and DHEA which are a precursory to testosterone
Premenopausally what proportion of testosterone is made by
1) Ovary
2) Adrenal glands
3) Peripheral conversion
Ovary 25%
Adrenal 25%
Peripheral 50%
What proportion of testosterone is unbound. What does it bind to?
Unbound 1-2%
Binds to SHGB 66% or albumin 33%
Which drugs can increase levels of SHBG?
Tamoxifen
PO estrogen
PO thyroxine
Reducing free androgen index
What factors decrease SHBG?
PO testosterone
Glucocorticoids
High fructose
Increased visceral adiposity
Insuline resistence
When is testosterone first noted?
Maturation of zona reticularis, 1st production of DHEA and DHEA-S age 6-8
Start of adrenarche
What age to testosterone levels peak?
18-24yrs
Age related atrophy of the adrenal gland, only 10% by the time menopause reached.
At menopause where is testosterone produced
50% ovaries
40% peripheral conversation
How to calculate free androgen index?
Total testosterone x 100/SHBG
If considering treatment with tesoterone, what levels should be measured?
Before treatment total testosterone, then 2-3 months after starting treatment
Ensure within reference range
Diagnosis of female sexual dysfunction
o >6 months & >75% sexual experiences
When can testosterone be considered for female sexual dysfunction
- In acquired hypoactive sexual desire disorder/dysfunction – all potential modifiable biopsychological factors should be identified & addresses, only if this fails should androgen therapy be used
When does NICE consider testosterone for low sexual desire?
NICE consider testosterone if oestrogen therapy alone is not effective for low sexual desire
Consider vaginal oestrogen if vaginal atrophy
Side effects of testosterone
acne, excess hair growth, alopecia, virilisation - stop quickly with stopping
Which patient should not have prescribed testosterone
active liver diease, competitive athletes, high testosterone levels
Is there are specific testosterone that is licences for use by women
No off licence - should explain this to patient
How should gel or cream be applied>
Gel/cream should be used on clean, dry skin on lower abdomen or upper thigh, avoid skin contact with others until the skin is dry & wash hand
How long does it take to see response to testosterone?
How often should review
- Response usually takes 8 weeks and needs minimum 3 months, no improvement after 6 months should be stopped
- Review minimum every 6 months to assess for SE
Research mostly used for 6-12 months so after this is efficacy and safety not known
