Menopause Live - IMS Updates

Date of release: 28 March, 2011

Endogenous androgens and effects on body fat and insulin resistance

In a recently published study, Casson and colleagues evaluated endogenous serum androgens and sex hormone binding globulin (SHBG) in 29 normal, non-obese, naturally occurring postmenopausal women whose ages ranged from 52 to 70 years [1]. Correlations were then evaluated between serum androgens and SHBG and insulin sensitivity, whole-body fat and lean body mass, visceral/abdominal fat areas per meter and aerobic capacity. Increased serum testosterone levels were related to greater maximal aerobic capacity and reduced adiposity. Higher serum levels of dihydrotestosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and androstenetriol glucuronidate were correlated with greater insulin sensitivity.


The use of replacement androgens, specifically transdermal testosterone and oral methyltestosterone, has principally been advocated in women with low libido or hypoactive sexual desire disorder [2,3]. Studies of transdermal testosterone have used women with and without intact ovaries, and the outcome has been to maintain serum testosterone in the physiologic range; the effects on libido have been measured with validated instruments. Concerns have been raised over cardiovascular outcomes and breast cancer, although there is little evidence to support or refute these concerns. Excess serum androgens, specifically testosterone, have been associated with the metabolic and morphologic changes associated with the polycystic ovarian syndrome (PCOS). Casson and colleagues [1] find that, in non-obese, postmenopausal women, testosterone is associated with a reduction in adiposity in contrast to that seen in the woman with PCOS. Testosterone levels also correlated with a better aerobic capacity. The authors speculate that these findings could represent just the general better health of the participants in the study. Testosterone in males and females does appear to reduce visceral adiposity, but the effects in women are inconsistent, with testosterone reducing the estrogen-associated reduction in visceral adiposity [4,5]. The effect of transdermal testosterone on weight and cardiovascular risk factors such as lipids is negligible in the clinical trials [3,6]. How testosterone affects the visceral adipocyte is unknown, but the clinical implications of reducing visceral fat accumulation are significant. Dehydroepiandrosterone and its sulfate (DHEA and DHEAS) are synthesized principally in the adrenal zona reticularis, and serum levels decline with age [7]. DHEA and DHEAS have been evaluated in only limited numbers of women in clinical trials; these have shown general improvement in well-being but no significant improvement in any disease process [8,9]. Serum levels of DHEAS, dihydrotestosterone, androstenedione and androstenetriol glucuronidate in the current article were associated with improved insulin sensitivity [1]. DHEA administration to women with impaired glucose intolerance was not found to alter insulin sensitivity [10]. The use of transdermal testosterone in women with low libido had no effect on serum hemoglobin A1c or fasting insulin levels [11]. A cross-sectional study of endogenous hormones in postmenopausal women who had no identifiable factors that would have affected their endogenous hormone levels did not find any correlations between serum DHEAS, testosterone, androstenedione and cardiovascular risk profiles [12]. Thus, the precise effect of DHEAS on insulin and its role in cardiovascular disease are unclear. In summary, declines in endogenous hormones with aging have been hypothesized to play a role in the occurrence of cardiovascular disease. Current evidence in support of this hypothesis is highly variable and limited, making it difficult to draw any meaningful conclusion. The role of adrenal androgens in postmenopausal health deserves greater investigation in order to clarify their role in age-related occurrence of disease.


David F. Archer
Professor of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA


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