Abstract
The expected postmenopausal lifetime of women in the western world is about 30 years. Hormones, such as estrogen and progestogen, may affect the quality of postmenopausal life and have been well studied. Androgens act on numerous tissues in the body, however little is known about their biological function in women and the possible effects of androgen insufficiency on womens health. Testosterone in women derives from direct ovarian production or from peripheral conversion of adrenal androgen precursors. Therefore loss of adrenal or ovarian function results in androgen deficiency. Oophorectomy reduces half the levels of testosterone in serum and may be associated with sexual problems and a decrease in psychological well-being. Several studies show positive effects of testosterone treatment on psychosexual function and physical as well as psychological well-being in women. Androgens also have positive metabolic effects on bone and body composition. According to a Cochrane review in 2005 there is evidence that the addition of testosterone to estrogen/progestogen therapy has a beneficial effect on sexual function in postmenopausal women. For pre- and perimenopausal women evidence is lacking. However there was a significant reduction of high density lipoprotein (HDL) cholesterol associated with the addition of testosterone to estrogen/progestogen regimens. Current testosterone replacement options differ between countries and so far only the testosterone patch has been approved by EMEA (European Medicines Agency) in 2006 for the treatment of sexual dysfunction in oophorectomized women. However, the definition of female androgen insufficiency, as provided by the Princeton consensus statement is being debated because the lack of a well-defined clinical syndrome and normative data on serum testosterone levels across the life span. The clinical guideline by the endocrine society in 2006 were against generalized use of testosterone because the indications are inadequate and long-term safety studies are lacking. Currently, testosterone therapy should be reserved for women with androgen deficiency due to low serum androgen levels and matching clinical signs and symptoms.
Keywords: Chemotherapy, cost of treatment, ovarian carcinoma, surgery, survival, Androgens, testosterone, sexual function, well-being, oophorectomy, lipids, bone, body-composition, female androgen insufficiency
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