Arlt Wiebke
Division of Medical Sciences, Institute of Biomedical Research, Endocrinology, Room 233, University of Birmingham, Birmingham, B15 2TT, UK.
Eur J Endocrinol. 2006 Jan;154(1):1-11. doi: 10.1530/eje.1.02062.
Androgens in women either derive from direct ovarian production or from peripheral conversion of the adrenal sex steroid precursor, dehydroepiandrosterone, towards active androgens. Therefore, loss of adrenal or ovarian function, caused by Addison's disease or consequent to bilateral oophorectomy, results in severe androgen deficiency, clinically often associated with a loss of libido and energy. Importantly, physiological menopause does not necessarily lead to androgen deficiency, as androgen synthesis in the ovaries may persist despite the decline in estrogen production. However, the definition of female androgen deficiency, as recently provided by the Princeton consensus statement, is not precise enough and may lead to over-diagnosis due to the high prevalence of its diagnostic criteria: androgen levels below or within the lower quartile of the normal range and concurrent sexual dysfunction. Importantly, physiological menopause is not necessarily associated with androgen deficiency and therefore does not routinely require androgen therapy. Current replacement options include transdermal testosterone administration or dehydroepiandrosterone treatment, both of which have been shown to result in significant improvements, in particular in libido and mood, while effects on body composition and muscular function are not well documented. It is important to keep in mind that the number of randomized controlled trials is still limited and that currently none of the available preparations is officially approved for use in women. Currently, androgen replacement should be reserved for women with severe androgen deficiency due to an established cause and matching clinical signs and symptoms.
女性体内的雄激素要么直接由卵巢分泌产生，要么由肾上腺性类固醇前体脱氢表雄酮经外周转化为活性雄激素而来。因此，由艾迪生病或双侧卵巢切除术后导致的肾上腺或卵巢功能丧失，会引起严重的雄激素缺乏，临床上常伴有性欲减退和精力下降。重要的是，生理性绝经不一定会导致雄激素缺乏，因为尽管雌激素分泌减少，但卵巢中的雄激素合成可能仍会持续。然而，普林斯顿共识声明最近给出的女性雄激素缺乏的定义不够精确，由于其诊断标准的高患病率，可能会导致过度诊断：雄激素水平低于正常范围的下四分位数或处于该范围内，同时伴有性功能障碍。重要的是，生理性绝经不一定与雄激素缺乏相关，因此通常不需要雄激素治疗。目前的替代选择包括经皮给予睾酮或进行脱氢表雄酮治疗，这两种方法都已显示出能带来显著改善，尤其是在性欲和情绪方面，而对身体成分和肌肉功能的影响尚无充分记录。需要牢记的是，随机对照试验的数量仍然有限，并且目前没有任何一种可用制剂被正式批准用于女性。目前，雄激素替代疗法应仅用于因明确病因且伴有相应临床体征和症状而导致严重雄激素缺乏的女性。
