Do androgens have physiologic relevance in women

The fundamental question about whether androgens matter in women is still not answered. Speculation that circulating androgens are physiologically relevant in women is based largely on circumstantial evidence. However, this evidence can be used to build a fairly strong case that they are important, certainly to the point where further research is warranted.

It is well established that androgens are not simply reproductive hormones. While they do have multiple reproductive effects both in the fetus and in postnatal life, acting to direct the development of sexual dimorphism and for maintenance of secondary sexual characteristics, they also are multi-system hormones with protean effects on multiple organ systems. Androgens act to enhance bone mass, potentiate certain cognitive behaviors, and enhance erythropoesis. They also modify hepatic protein secretion, stimulate kidney and muscle hypertrophy, and modify patterns of adipose tissue deposition. They are clearly related to skin and appendage function and finally, may have certain immune-enhancing effects.

Further evidence of their potential multi-system role in human physiology is demonstrated by the fact that in human tissues there is a wide distribution of androgen receptor expression (Wilson and Mc Phaul 1996). As seen in Table 17.2, there

Table 17.2 Distribution of androgen receptors in women

Reproductive Tissue

Expression Level

Non-reproductive Tissue

Expression Level

Prostate

1.0

Endometrial carcinoma

0.8

Testis

0.9

Prostate arcinoma

0.5

Seminal vesicles

0.7

Kidney

0.4

Ejaculatory duct

0.4

Thyroid carcinoma

0.4

Endometrium

1.8

Breast

0.3

Ovary

1.5

Colon

0.1

Uterus

1.4

Lung

0.07

Falloian tube

1.0

Adrenal

0.03

Myometrium

0.6

Adapted from Wilson 1996.

Adapted from Wilson 1996.

is significant androgen receptor expression in male and female non-reproductive tissues, including kidney, thyroid, breast, colon, lung and adrenal glands. There is also significant expression in female reproductive tissues including endometrium, ovary, uterus, fallopian tube and myometrium.

A speculative line of reasoning that androgens are physiologically important hormones in women is that there might be parallels between female and male androgen deficiency. Testosterone deficiency in men, from either surgical or natural hypogonadism, is a well defined state, and the sequelae are outlined extensively in chapter 13. These men are obese, insulin resistant, at risk for heart disease, have decreased muscle mass and strength, are certainly at risk for osteoporosis, and clearly have diminished sexual function. The question is automatically raised: is there a similar clinical syndrome in women, albeit subtler? We believe what little data does exist in this regard supports this contention.

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