Female androgen insufficiency: the Princeton consensus statement on definition, classification, and assessment.
OBJECTIVE
To evaluate the evidence for and against androgen insufficiency as a cause of sexual and other health-related problems in women and to make recommendations regarding definition, diagnosis, and assessment of androgen deficiency states in women.


METHODS
Evaluation of peer-review literature and consensus conference of international experts.


METHODS
Multinational conference in the United States.


METHODS
Premenopausal and postmenopausal women with androgen deficiency.


METHODS
Evaluation of peer-review literature and development of consensus panel guidelines.


RESULTS
The term "female androgen insufficiency" was defined as consisting of a pattern of clinical symptoms in the presence of decreased bioavailable T and normal estrogen status. Currently available assays were found to be lacking in sensitivity and reliability at the lower ranges, and the need for an equilibrium dialysis measure was strongly emphasized. Causes of androgen insufficiency in women were classified as ovarian, adrenal, hypothalamic-pituitary, drug-related, and idiopathic. A simplified management algorithm and clinical guidelines were proposed to assist clinicians in diagnosis and assessment. Androgen replacement is currently available in several forms, although none has been approved for treatment of sexual dysfunction or other common symptoms of female androgen insufficiency. Potential risks associated with treatment were identified, and the need for informed consent and careful monitoring was noted. Finally, the panel identified key goals and priorities for future research.


CONCLUSIONS
A new definition of androgen insufficiency in women has been proposed along with consensus-based guidelines for clinical assessment and diagnosis. A simplified management algorithm for women with low androgen in the presence of clinical symptoms and normal estrogen status has also been proposed.
Bachmann
Gloria
G
Robert Wood Johnson Medical School, Women's Health Institute, New Jersey, New Brunswick, USA.
Bancroft
John
J
Braunstein
Glenn
G
Burger
Henry
H
Davis
Susan
S
Dennerstein
Lorraine
L
Goldstein
Irwin
I
Guay
Andre
A
Leiblum
Sandra
S
Lobo
Rogerio
R
Notelovitz
Morris
M
Rosen
Raymond
R
Sarrel
Philip
P
Sherwin
Barbara
B
Simon
James
J
Simpson
Evan
E
Shifren
Jan
J
Spark
Richard
R
Traish
Abdul
A
D000728:Androgens / Q000008:administration & dosage / Q000096:biosynthesis / Q000097:blood / Q000172:deficiency*; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006292:Health Priorities; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D012106:Research; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013739:Testosterone / Q000097:blood; D016387:Women's Health
D000728:Androgens; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D019314:Dehydroepiandrosterone Sulfate