title: Effect of postmenopausal estrogen replacement on circulating androgens.
abstract: OBJECTIVE
  To determine the effect of estrogen replacement therapy (ERT) on serum androgen levels in postmenopausal women.
  
  
  METHODS
  We measured serum dehydroepiandrosterone (DHEA), DHEA-sulfate, testosterone, estradiol (E2), LH, FSH, and sex hormone binding globulin in 8:00 AM fasting serum samples from a previous randomized, blinded, placebo-controlled crossover study in which 28 postmenopausal women (27 naturally menopausal) were given 2 mg/day of oral micronized estradiol. The treatment arms were 12 weeks with a 6-week washout.
  
  
  RESULTS
  Estrogen replacement therapy raised mean (+/- standard error of the mean [SEM]) serum E2 from 8.7 +/- 1.0 to 117 +/- 18.7 pg/mL (P < .001 from baseline). Concurrently, mean (+/- SEM) DHEA-sulfate fell from 67.3 +/- 9.6 to 52.1 +/- 6.4 micrograms/dL (P < .001), and mean (+/- SEM) testosterone fell from 16.1 +/- 2.4 to 9.4 +/- 1.4 ng/dL (P = .006). Both FSH and LH declined significantly. Sex hormone binding globulin increased by 160% with ERT (P < .001).
  
  
  CONCLUSIONS
  Menopausal ERT decreases serum androgen levels, decreasing DHEA-sulfate and testosterone by 23% and 42%, respectively. Whereas the decline in testosterone is likely due to decreased LH-driven ovarian stromal steroidogenesis, the declining levels of DHEA-sulfate also may imply a direct adrenal effect of estrogen. Bioavailable testosterone likely is reduced even more profoundly because sex hormone binding globulin is increased 160% by estrogen. Thus, menopausal ERT may induce relative ovarian and adrenal androgen deficiency, creating a rationale for concurrent physiologic androgen replacement.
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA. pcasson@bcm.tmc.edu
authors.forename: P R
authors.initials: PR
authors.lastname: Casson
authors.forename: K E
authors.initials: KE
authors.lastname: Elkind-Hirsch
authors.forename: J E
authors.initials: JE
authors.lastname: Buster
authors.forename: P J
authors.initials: PJ
authors.lastname: Hornsby
authors.forename: S A
authors.initials: SA
authors.lastname: Carson
authors.forename: M C
authors.initials: MC
authors.lastname: Snabes
mesh_terms: D000368:Aged; D000728:Androgens / Q000097:blood*; D018592:Cross-Over Studies; D003687:Dehydroepiandrosterone / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004311:Double-Blind Method; D016903:Drug Monitoring; D004958:Estradiol / Q000097:blood / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy / Q000379:methods*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008875:Middle Aged; D017698:Postmenopause / Q000097:blood* / Q000187:drug effects*; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013739:Testosterone / Q000097:blood
chemical_list: D000728:Androgens; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D003687:Dehydroepiandrosterone; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone