Androgen deficiency explained

Androgen deficiency
Synonyms:Hypoandrogenism, androgen deficiency syndrome, men with hypogonadism, testosterone deficiency

Androgen deficiency is a medical condition characterized by insufficient androgenic activity in the body. Androgen deficiency most commonly affects women, and is also called Female androgen insufficiency syndrome (FAIS), although it can happen in both sexes.[1] [2] Androgenic activity is mediated by androgens (a class of steroid hormones with varying affinities for the androgen receptor), and is dependent on various factors including androgen receptor abundance, sensitivity and function. Androgen deficiency is associated with lack of energy and motivation, depression, lack of desire (libido), and in more severe cases changes in secondary sex characteristics.[2] [3] [4] [5] [6] [7] [8]

Signs and symptoms

Symptoms of the condition in males consist of loss of libido, impotence, infertility, shrinkage of the testicles, penis, and prostate, diminished masculinization (e.g., decreased facial and body hair growth), low muscle mass, anxiety, depression, fatigue, vasomotor symptoms (hot flashes), insomnia, headaches, cardiomyopathy and osteoporosis. In addition, symptoms of hyperestrogenism, such as gynecomastia and feminization, may be concurrently present in males.[9]

In males, a type of myopathy can result from androgen deficiency known as testosterone deficiency myopathy or (hypogonadotropic) hypogonadism with myopathy. Signs and symptoms include elevated serum CK, symmetrical muscle wasting and muscle weakness (predominantly proximal), a burning sensation in the feet at night, waddling gait, and impaired fasting glucose. EMG showed low volitional contraction of short duration polyphasic units. Muscle biopsy showed evidence of myonecrosis and regeneration, some fibre splitting, chronic inflammatory cells (macrophages) infiltrating degenerating fibres, and an increase in adipose and fibrous tissue (fibrosis). A predominance of type I (slow-twitch/oxidative) muscle fibres, with some mixed atrophy of type II (fast-twitch/glycolytic) muscle fibres. Treatment is hormone replacement therapy of testosterone.[10] [11] [12]

In females, hypoandrogenism consist of loss of libido, decreased body hair growth, depression, fatigue, vaginal vasocongestion (which can result in cramps), vasomotor symptoms (e.g., hot flashes and palpitations), insomnia, headaches, osteoporosis and reduced muscle mass.[13] [14] [15] As estrogens are synthesized from androgens, symptoms of hypoestrogenism may be present in both sexes in cases of severe androgen deficiency.

Causes

Hypoandrogenism is primarily caused by either dysfunction, failure, or absence of the gonads (hypergonadotropic) or impairment of the hypothalamus or pituitary gland (hypogonadotropic). This in turn can be caused by a multitude of different stimuli, including genetic conditions (e.g., GnRH/gonadotropin insensitivity and enzymatic defects of steroidogenesis), tumors, trauma, surgery, autoimmunity, radiation, infections, toxins, drugs, and many others. It may also be the result of conditions such as androgen insensitivity syndrome or hyperestrogenism. Old age may also be a factor in the development of hypoandrogenism, as androgen levels decline with age.[16]

Diagnosis

Diagnosis of androgenic deficiency in males is based on symptoms together with at least two measurements of testosterone done first thing in the morning after a period of not eating. In those without symptoms, testing is not generally recommended.[17] Androgen deficiency is not usually checked for diagnosis in healthy women.[18]

Treatment

See also: Testosterone (medication). Treatment may consist of hormone replacement therapy with androgens in those with symptoms.[17] Treatment mostly improves sexual function in males.[17]

Gonadotropin-releasing hormone (GnRH)/GnRH agonists or gonadotropins may be given (in the case of hypogonadotropic hypoandrogenism). The Food and Drug Administration (FDA) stated in 2015 that neither the benefits nor the safety of testosterone have been established for low testosterone levels due to aging.[19] The FDA has required that testosterone pharmaceutical labels include warning information about the possibility of an increased risk of heart attacks and stroke.[19]

See also

Notes and References

  1. Androgen insufficiency in women: diagnostic and therapeutic implications. L. M.. Rivera-Woll. M.. Papalia. S. R.. Davis. H. G.. Burger. October 1, 2004. Human Reproduction Update. 10. 5. 421–432. 10.1093/humupd/dmh037. 15297435. free.
  2. Androgen insufficiency in women: summary of critical issues. Glenn D. Braunstein. April 1, 2002. Fertility and Sterility. 77. 94–99. 10.1016/S0015-0282(02)02962-X. 12007911. free.
  3. Androgen insufficiency in women. Glenn D.. Braunstein. July 1, 2006. Growth Hormone & IGF Research. 16. 109–117. 10.1016/j.ghir.2006.03.009. 16631401.
  4. Tan . RS . Testosterone replacement therapy for female androgen insufficiency syndrome . International Journal of Pharmaceutical Compounding . July 2005 . 9 . 4 . 259–64 . 23925049 .
  5. Androgens in women. Sonia L. Davison. Susan R. Davis. June 1, 2003. The Journal of Steroid Biochemistry and Molecular Biology. 85. 2. 363–366. 10.1016/S0960-0760(03)00204-8. 12943723. 8048483.
  6. Guay . A . Traish . A . Testosterone therapy in women with androgen deficiency: Its time has come . Current Opinion in Investigational Drugs . October 2010 . 11 . 10 . 1116–26 . 20872314 . 24910370 .
  7. Serum androgen levels in healthy premenopausal women with and without sexual dysfunction: Part A. Serum androgen levels in women aged 20–49 years with no complaints of sexual dysfunction. A.. Guay. R.. Munarriz. J.. Jacobson. L.. Talakoub. A.. Traish. F.. Quirk. I.. Goldstein. R.. Spark. April 24, 2004. International Journal of Impotence Research. 16. 2. 112–120. 10.1038/sj.ijir.3901178. 14999217. 22139942 .
  8. 2021-05-17 . Corrigendum to: "Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline" . The Journal of Clinical Endocrinology & Metabolism . 106 . 7 . e2843 . 10.1210/clinem/dgab306 . 0021-972X.
  9. Ponholzer . Anton . Madersbacher . Stephan . May 2009 . Re: Christina Wang, Eberhard Nieschlag, Ronald Swerdloff, et al. Investigation, Treatment, and Monitoring of Late-Onset Hypogonadism in Males: ISA, ISSAM, EAU, EAA, and ASA Recommendations. Eur Urol 2009;55:121–30 . European Urology . 55 . 5 . e92; author reply e93-4 . 10.1016/j.eururo.2008.11.053 . 19081175 . 0302-2838.
  10. Needham, Merrilee, and Frank Mastaglia, 'Endocrine myopathies', in David Hilton-Jones, and Martin R. Turner (eds), Oxford Textbook of Neuromuscular Disorders, Ch. 38 Endocrine myopathies. Oxford Textbooks in Clinical Neurology (Oxford, 2014; online edn, Oxford Academic, 1 May 2014), . Retrieved 29 May 2023.
  11. Orrell . R W . Woodrow . D F . Barrett . M C . Press . M . Dick . D J . Rowe . R C . Lane . R J . August 1995 . Testosterone deficiency myopathy. . Journal of the Royal Society of Medicine . 88 . 8 . 454–456 . 0141-0768 . 1295300 . 7562829.
  12. Haq . T. . Pathan . M. F. . Ikhtaire . S. . January 2016 . Hypogonadotropic Hypogonadism in a Boy with Myopathy . Mymensingh Medical Journal: MMJ . 25 . 1 . 186–189 . 1022-4742 . 26931274.
  13. Jakiel G, Baran A . [Androgen deficiency in women] . pl . Endokrynologia Polska . 56 . 6 . 1016–20 . 2005 . 16821229 .
  14. Bachmann GA . The hypoandrogenic woman: pathophysiologic overview . Fertility and Sterility . 77 . S72–6 . April 2002 . Suppl 4 . 12007907 . 10.1016/S0015-0282(02)03003-0 . free .
  15. Book: Bremner, William J. . vanc . Androgens in Health and Disease . 11 June 2012 . 27 May 2003 . Humana Press . 978-1-58829-029-8 . 365–379.
  16. Barratt . Christopher L R . Björndahl . Lars . De Jonge . Christopher J . Lamb . Dolores J . Osorio Martini . Francisco . McLachlan . Robert . Oates . Robert D . van der Poel . Sheryl . St John . Bianca . Sigman . Mark . Sokol . Rebecca . Tournaye . Herman . 2017-11-01 . The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance—challenges and future research opportunities . Human Reproduction Update . en . 23 . 6 . 660–680 . 10.1093/humupd/dmx021 . 1355-4786 . 5850791 . 28981651.
  17. Bhasin . S . Brito . JP . Cunningham . GR . Hayes . FJ . Hodis . HN . Matsumoto . AM . Snyder . PJ . Swerdloff . RS . Wu . FC . Yialamas . MA . Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. . The Journal of Clinical Endocrinology and Metabolism . 1 May 2018 . 103 . 5 . 1715–1744 . 10.1210/jc.2018-00229 . 29562364. free .
  18. Wierman ME, Arlt W, Basson R, Davis SR, Miller KK, Murad MH, Rosner W, Santoro N . Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline . The Journal of Clinical Endocrinology and Metabolism . 99 . 10 . 3489–510 . October 2014 . 25279570 . 10.1210/jc.2014-2260 . free .
  19. Web site: Staff . Testosterone Products: Drug Safety Communication — FDA Cautions About Using Testosterone Products for Low Testosterone Due to Aging; Requires Labeling Change to Inform of Possible Increased Risk of Heart Attack And Stroke . 3 March 2015 . . 5 March 2015 .

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