Androgen deficiency: menopause and estrogen-related factors.

Objective: To describe the changes in ovarian hormones caused by natural menopause and hormone replacement therapy that have effects on androgen bioavailability and to describe indications for androgen replacement in postmenopausal women.

Design: Review of English language-published research over the last 35 years from January 1, 1966 to June 30, 2001 using MEDLINE.

Setting: Academic medical center.

Intervention(s): None.

Result(s): In menopausal women, the effects of estradiol depletion and replacement on sex hormone-binding globulin appear to have clinically significant effects on bioavailable endogenous androgens. Many women whose menopause-related symptoms and bone loss responded inadequately to estrogen replacement were found to benefit from the addition of androgens. Most studies have focused on the sexual benefits of prescribing androgens to postmenopausal women. New studies have begun exploring the effects of androgens in other body systems, including the brain and the cardiovascular system.

Conclusion(s): Estrogen depletion and replacement therapy at menopause can have clinically significant effects on bioavailability of endogenous androgens. Androgens complement the actions of estrogens in symptom control and disease prevention in postmenopausal women. Although androgen effects on sexual function are important, effects of androgens in many body systems should be considered in future research to determine optimal postmenopausal hormone replacement therapy.