An increasing number of researchers is looking at the phenomenon of androgen deficiency in women (Miller 2001), as levels of dehydroepiandrosterone (DHEA) and testosterone fall steadily with age and contribute to many of the symptoms seen in postmenopause.   Androgen therapy with DHEA or testosterone has been found to restore sexual function, particularly in women who have experienced a sudden drop in androgen levels, such as younger women undergoing surgical menopause, or women with adrenal insufficiency (Arlt 2006).  DHEA has been found to successfully restore sexual function in older women and has had a good safety profile, even after 50 mg/day oral DHEA was administered for one year, as found in the DHEAge study, which also found an increase in bone mineral density with DHEA treatment in women over 70 years old (Baulieu et al. 2000).  Labrie et al. (2005) have suggested the use of DHEA for physiological hormone replacement because of its nature as a hormone precursor, producing estrogens and testosterone in the hormone-dependent target tissues precisely according to local needs, and thus alleviating many of the symptoms of hormone deficiency while avoiding the systemic side effects of exogenous hormone therapy. They call this new concept “intracrinology” as opposed to endocrinology and suggest that it offers new options for menopausal women.  Arlt (2006) has reviewed the use of androgen therapy in women and concluded that this should be reserved for women with severe androgen insufficiency.  

• Arlt W.  Androgen therapy in women.  Eur J Endocrinol 2006; 154:1-11.  
  
  This is a current review of the use of androgen therapy in women by a leading specialist in this area.  It concludes that treatment with androgens should be reserved for younger women undergoing surgical menopause, or women with severe adrenal insufficiency.   Androgen therapy with DHEA or testosterone has been found to restore sexual function, particularly in women who have experienced a sudden drop in androgen levels after surgical menopause (removal of the ovaries).

• Labrie F, Luu-The V, Bélanger A, Lin S-X, Simard J, Pelletier G.  Is dehydroepiandrosterone a hormone?  J Endocrinol 2005; 187:169-96. 
  
  These researchers suggest the use of DHEA for physiological hormone replacement because of its nature as a hormone precursor, producing estrogens and testosterone in the hormone-dependent target tissues precisely according to local needs.  It could thus alleviate many of the symptoms of hormone deficiency while avoiding the systemic side effects of too much direct hormone therapy with estrogens or testosterone. They call this new concept “intracrinology” as opposed to endocrinology and suggest that it offers new options for menopausal women. 

• Schneider HP. Androgens and antiandrogens. Ann N Y Acad Sci. 2003 Nov;997:292-306.
  
  
• Lobo RA. Androgens in postmenopausal women: production, possible role, and replacement options. Obstet Gynecol Surv. 2001 Jun;56(6):361-76.
  
  
• Miller KK. Androgen deficiency in women. J Clin Endocrinol Metab 2001 Jun;86(6):2395-401.
  
  
• Simon JA. Safety of estrogen/androgen regimens. J Reprod Med 2001 Mar;46(3 Suppl):281-90.
  
  
• Baulieu E-E, Thomas G, Legrain S, Lahlou N, Roger M, Debuire B, Faucounau V, Girard L, Hervy M-P, Latour F, Leaud M-C, Mokrane A, Pitti-Ferrandi H, Trivalle C, de Lacharriere O, Nouveau S, Rakoto-Arison B, Souberbielle J-C, Raison J, Le Bouc Y, Raynaud A, Girerd X, Forette F.  Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge study to a sociobiomedical issue.  Proc Natl Acad Sci 2000; 97(8):4279-84. 
  
  DHEA successfully restored sexual function in older women and had a good safety profile, even after 50 mg/day oral DHEA was administered for one year, in the DHEAge study, which also found an increase in bone mineral density with DHEA treatment in women over 70 years old.
  
  
• Stoll BA. Dietary supplements of dehydroepiandrosterone in relation to breast cancer risk. Eur J Clin Nutr 1999 Oct;53(10):771-5.
   
• Wiebke, A, Callies, F, Van Vlijmen, J, Koehler, I, Reincke, M, Bidlingmaier, M, Huebler, D, Oettel, M, Ernst, M, Schulte, H, Allolio, B. Dehydroepiandrosterone replacement in women with adrenal insufficiency. The New England Journal of Medicine , 1999;341(14):1013-19.
  
  This double-blind crossover study reviewed alternately the effects of 50mg of oral dehydroepiandrosterone (DHEA) daily with placebo in 24 women with adrenal insufficiency. Participants were evaluated using established well-being (depression and anxiety scores) and sexuality (thoughts, interest, satisfaction) scales and serum profiles. Results showed that serum DHEA, DHEA-S and active androgen increased to normal or low-normal levels during treatment. SHBG levels were significantly lower following treatment. IGF-I concentrations increased after treatment (only in women with primary adrenal insufficiency), but IGF-binding protein 3 levels did not change. Serum total and HDL lipoprotein cholesterol levels decreased significantly during treatment. LDL and triglyceride concentrations did not change significantly. Psychological testing scores for well-being and sexuality both improved significantly during treatment. These effects were noticed after treatment for four months, but not after treatment for one month. Authors recommended that treatment with DHEA should be part of hormone replacement therapy for women with adrenal insufficiency.
  
  
• Arlt W, Callies F, van Vlijmen JC, Koehler I, Reincke M, Bidlingmaier M, Huebler D, Oettel M, Ernst M, Schulte HM, Allolio B. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med 1999 Sep 30;341(14):1013-20.
  
  
• Davis SR.The therapeutic use of androgens in women. J Steroid Biochem Mol Biol. 1999 Apr-Jun;69(1-6):177-84.
  
  
• Rako S.Testosterone deficiency: a key factor in the increased cardiovascular risk to women following hysterectomy or with natural aging? J Womens Health. 1998 Sep;7(7):825-9.

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