-
Asian Journal of Andrology 2014
Topics: Androgens; Humans; Male; Syndrome
PubMed: 24480923
DOI: 10.4103/1008-682X.122587 -
Fertility and Sterility Apr 2002To evaluate the evidence for and against androgen insufficiency as a cause of sexual and other health-related problems in women and to make recommendations regarding... (Review)
Review
OBJECTIVE
To evaluate the evidence for and against androgen insufficiency as a cause of sexual and other health-related problems in women and to make recommendations regarding definition, diagnosis, and assessment of androgen deficiency states in women.
DESIGN
Evaluation of peer-review literature and consensus conference of international experts.
SETTING
Multinational conference in the United States.
PATIENT(S)
Premenopausal and postmenopausal women with androgen deficiency.
INTERVENTION(S)
Evaluation of peer-review literature and development of consensus panel guidelines.
RESULT(S)
The term "female androgen insufficiency" was defined as consisting of a pattern of clinical symptoms in the presence of decreased bioavailable T and normal estrogen status. Currently available assays were found to be lacking in sensitivity and reliability at the lower ranges, and the need for an equilibrium dialysis measure was strongly emphasized. Causes of androgen insufficiency in women were classified as ovarian, adrenal, hypothalamic-pituitary, drug-related, and idiopathic. A simplified management algorithm and clinical guidelines were proposed to assist clinicians in diagnosis and assessment. Androgen replacement is currently available in several forms, although none has been approved for treatment of sexual dysfunction or other common symptoms of female androgen insufficiency. Potential risks associated with treatment were identified, and the need for informed consent and careful monitoring was noted. Finally, the panel identified key goals and priorities for future research.
CONCLUSION(S)
A new definition of androgen insufficiency in women has been proposed along with consensus-based guidelines for clinical assessment and diagnosis. A simplified management algorithm for women with low androgen in the presence of clinical symptoms and normal estrogen status has also been proposed.
Topics: Androgens; Dehydroepiandrosterone Sulfate; Diagnosis, Differential; Female; Health Priorities; Hormone Replacement Therapy; Humans; Research; Sex Hormone-Binding Globulin; Testosterone; Women's Health
PubMed: 11937111
DOI: 10.1016/s0015-0282(02)02969-2 -
The Journal of Endocrinology Jun 2024Androgens can modulate immune cell function and may contribute to differences in the prevalence and severity of common inflammatory conditions. Although most immune... (Review)
Review
Androgens can modulate immune cell function and may contribute to differences in the prevalence and severity of common inflammatory conditions. Although most immune cells are androgen targets, our understanding of how changes in androgen bioavailability can affect immune responses is incomplete. Androgens alter immune cell composition, phenotype, and activation by modulating the expression and secretion of inflammatory mediators or by altering the development and maturation of immune cell precursors. Androgens are generally associated with having suppressive effects on the immune system, but their impacts are cell and tissue context-dependent and can be highly nuanced even within immune cell subsets. In response to androgens, innate immune cells such as neutrophils, monocytes, and macrophages increase the production of the anti-inflammatory cytokine IL-10 and decrease nitric oxide production. Androgens promote the differentiation of T cell subsets and reduce the production of inflammatory mediators, such as IFNG, IL-4 and IL-5. Additionally, androgens/androgen receptor can promote the maturation of B cells. Thus, androgens can be considered as immunomodulatory agents, but further work is required to understand the precise molecular pathways that are regulated at the intersection between endocrine and inflammatory signals. This narrative review focusses on summarising our current understanding of how androgens can alter immune cell function and how this might affect inflammatory responses in health and disease.
Topics: Humans; Androgens; Animals; Inflammation; Immune System; Receptors, Androgen
PubMed: 38579776
DOI: 10.1530/JOE-23-0398 -
Journal of Clinical Research in... Mar 2017Congenital adrenal hyperplasia (CAH) is classified as classical CAH and non-classical CAH (NCCAH). In the classical type, the most severe form comprises both... (Review)
Review
Congenital adrenal hyperplasia (CAH) is classified as classical CAH and non-classical CAH (NCCAH). In the classical type, the most severe form comprises both salt-wasting and simple virilizing forms. In the non-classical form, diagnosis can be more confusing because the patient may remain asymptomatic or the condition may be associated with signs of androgen excess in the postnatal period or in the later stages of life. This review paper will include information on clinical findings, symptoms, diagnostic approaches, and treatment modules of NCCAH.
Topics: Adrenal Hyperplasia, Congenital; Child; Diagnosis, Differential; Female; Genetic Testing; Humans; Male; Mutation; Steroid 21-Hydroxylase; Virilism
PubMed: 27354284
DOI: 10.4274/jcrpe.3378 -
The Journal of Clinical Endocrinology... Apr 2021Virilization is the medical term for describing a female who develops characteristics associated with male hormones (androgens) at any age, or when a newborn girl shows... (Review)
Review
UNLABELLED
Virilization is the medical term for describing a female who develops characteristics associated with male hormones (androgens) at any age, or when a newborn girl shows signs of prenatal male hormone exposure at birth. In girls, androgen levels are low during pregnancy and childhood. A first physiologic rise of adrenal androgens is observed at the age of 6 to 8 years and reflects functional activation of the zona reticularis of the adrenal cortex at adrenarche, manifesting clinically with first pubic and axillary hairs. Early adrenarche is known as "premature adrenarche." It is mostly idiopathic and of uncertain pathologic relevance but requires the exclusion of other causes of androgen excess (eg, nonclassic congenital adrenal hyperplasia) that might exacerbate clinically into virilization. The second modest physiologic increase of circulating androgens occurs then during pubertal development, which reflects the activation of ovarian steroidogenesis contributing to the peripheral androgen pool. However, at puberty initiation (and beyond), ovarian steroidogenesis is normally devoted to estrogen production for the development of secondary female bodily characteristics (eg, breast development). Serum total testosterone in a young adult woman is therefore about 10- to 20-fold lower than in a young man, whereas midcycle estradiol is about 10- to 20-fold higher. But if androgen production starts too early, progresses rapidly, and in marked excess (usually more than 3 to 5 times above normal), females will manifest with signs of virilization such as masculine habitus, deepening of the voice, severe acne, excessive facial and (male typical) body hair, clitoromegaly, and increased muscle development. Several medical conditions may cause virilization in girls and women, including androgen-producing tumors of the ovaries or adrenal cortex, (non)classical congenital adrenal hyperplasia and, more rarely, other disorders (also referred to as differences) of sex development (DSD). The purpose of this article is to describe the clinical approach to the girl with virilization at puberty, focusing on diagnostic challenges. The review is written from the perspective of the case of an 11.5-year-old girl who was referred to our clinic for progressive, rapid onset clitoromegaly, and was then diagnosed with a complex genetic form of DSD that led to abnormal testosterone production from a dysgenetic gonad at onset of puberty. Her genetic workup revealed a unique translocation of an abnormal duplicated Y-chromosome to a deleted chromosome 9, including the Doublesex and Mab-3 Related Transcription factor 1 (DMRT1) gene.
LEARNING OBJECTIVES
Identify the precise pathophysiologic mechanisms leading to virilization in girls at puberty considering that virilization at puberty may be the first manifestation of an endocrine active tumor or a disorder/difference of sex development (DSD) that remained undiagnosed before and may be life-threatening. Of the DSDs, nonclassical congenital adrenal hyperplasia occurs most often.Provide a step-by-step diagnostic workup plan including repeated and expanded biochemical and genetic tests to solve complex cases.Manage clinical care of a girl virilizing at puberty using an interdisciplinary team approach.Care for complex cases of DSD manifesting at puberty, such as the presented girl with a Turner syndrome-like phenotype and virilization resulting from a complex genetic variation.
Topics: Adrenal Hyperplasia, Congenital; Adrenarche; Androgens; Child; Female; Humans; Puberty; Virilism
PubMed: 33367768
DOI: 10.1210/clinem/dgaa948 -
International Journal of Molecular... Jun 2013The role of autophagy is known to be highly complex and context-dependent, leading to both cancer suppression and progression in several tumors including melanoma,... (Review)
Review
The role of autophagy is known to be highly complex and context-dependent, leading to both cancer suppression and progression in several tumors including melanoma, breast and prostate cancer. In the present review, recent advances in an understanding of the involvement of autophagy in prostate cancer treatment are described. The regulatory effects of androgens on prostate cancer cell autophagy are particularly discussed in order to highlight the effects of autophagy modulation during androgen deprivation. A critical evaluation of the studies examined in the present review suggests the attractive possibility of autophagy inhibition combined with hormonal therapy as a promising approach for prostate cancer treatment.
Topics: Androgens; Animals; Autophagy; Disease Progression; Humans; Immunity; Male; Models, Biological; Prostatic Neoplasms
PubMed: 23743823
DOI: 10.3390/ijms140612090 -
Fertility and Sterility Apr 2002Women experience a significant decline in circulating androgen concentrations after bilateral oophorectomy. Despite several limitations, studying women after... (Review)
Review
Women experience a significant decline in circulating androgen concentrations after bilateral oophorectomy. Despite several limitations, studying women after oophorectomy remains a good model for investigating the effects of both androgen deficiency and androgen replacement. Current data show that most women experience satisfying sexual lives after hysterectomy and bilateral oophorectomy. This is reassuring since elective oophorectomy at the time of hysterectomy is an appropriate option for many women. Oophorectomized women, however, are more likely to report a worsening of sexual function after hysterectomy compared with women who retain their ovaries. Specifically, adverse changes in libido and orgasmic response are more likely in oophorectomized women. After bilateral oophorectomy, women also appear more likely to experience decreased positive psychological well-being. Studies of both the consequences of oophorectomy and the effects of testosterone replacement are consistent with an important role for androgens in female sexual function and psychological well-being.
Topics: Androgens; Female; Hormone Replacement Therapy; Humans; Hysterectomy; Middle Aged; Ovariectomy; Sexuality
PubMed: 12007904
DOI: 10.1016/s0015-0282(02)02970-9 -
Fertility and Sterility Aug 2004Review of literature with regard to androgen replacement therapy in women. (Review)
Review
OBJECTIVE
Review of literature with regard to androgen replacement therapy in women.
DESIGN
Review of the MEDLINE database and references from articles.
CONCLUSIONS
Androgens affect sexual function, bone health, muscle mass, body composition, mood, energy, and the sense of well-being. Androgen insufficiency clearly has been demonstrated in patients with hypopituitarism, adrenalectomy, oophorectomy, and in some women placed on oral estrogen therapy which increases sex hormone-binding globulin (SHBG) levels and lowers the free and bioavailable forms of T. Symptoms of androgen insufficiency in women may include a diminished sense of well-being, low mood, fatigue, and hypoactive sexual desire disorder with decreased libido, or decreased sexual receptivity and pleasure that causes a great deal of personal distress. The preponderance of evidence from clinical trials supports the correlation of decreased endogenous androgen levels with these symptoms and alleviation of many of the symptoms with the administration of T or, in some cases, DHEA. There are no Food and Drug Administration-approved androgen preparations on the market for treating androgen insufficiency in women. The safety profile of androgens in doses used for the treatment of hypoactive sexual desire disorder has been excellent with only mild acne and hirsutism being noted in a minority of patients.
Topics: Androgens; Clinical Trials as Topic; Dehydroepiandrosterone; Female; Hormone Replacement Therapy; Humans; MEDLINE; Sexuality
PubMed: 15302268
DOI: 10.1016/j.fertnstert.2003.11.062 -
Fertility and Sterility Apr 2002To review the pathophysiologic changes associated with androgen insufficiency in the female. (Review)
Review
OBJECTIVE
To review the pathophysiologic changes associated with androgen insufficiency in the female.
DESIGN
A review of the English-language literature from 1940 to 2001.
CONCLUSION(S)
Data suggest that diminished androgen levels, most frequently noted in the surgically menopausal patient, may be associated with a number of symptoms including reduced sexual libido and desire, loss of motivation, flat affect, and reduced energy. Lack of consensus in defining abnormally low values for free and total serum androgen levels have made the definition of hypoandrogenic states difficult.
Topics: Androgens; Female; Hormone Replacement Therapy; Humans; Ovariectomy; Ovary
PubMed: 12007907
DOI: 10.1016/s0015-0282(02)03003-0 -
The Journal of Investigative... Dec 2005The pilosebaceous unit (PSU) response to androgen is variable. Certain population of PSU respond to androgen in a distinctive pattern that results in sexual hair... (Review)
Review
The pilosebaceous unit (PSU) response to androgen is variable. Certain population of PSU respond to androgen in a distinctive pattern that results in sexual hair development in some, sebaceous gland development in others. Furthermore, androgen excess is variably manifest in women as hirsutism, acne vulgaris, seborrhea, or pattern alopecia. Although sebaceous cells act as intracrine cells, activating pro-hormones to potent androgens that act within the sebocyte, hair follicle metabolism predominantly inactivates testosterone. Androgen action in the sexual hair follicle appears to be mediated by the dermal papilla and possibly, by inducing expression of a specific keratin, hHa7, in the hair medulla. The data do not clearly support a relationship between idiopathic hirsutism, the hirsutism that occurs in the absence of androgen excess, and variations in androgen mechanism of action. Androgens are prominent among the hormones that modulate the biological mechanism regulating the hair cycle. However, the basis for the variable pattern of PSU response to androgen is unclear, as is the basis for the variable development of hirsutism in response to androgen excess and the incomplete reversal of hirsutism by anti-androgen treatment. Improved treatment of hirsutism awaits improved understanding of the nature of the interaction between androgens and other determinants of hair follicle biology.
Topics: Androgens; Female; Hair; Hair Follicle; Hirsutism; Hormones; Humans; Male; Sebaceous Glands; Sex Characteristics
PubMed: 16382665
DOI: 10.1111/j.1087-0024.2005.10106.x