title: Androgen therapy in women: for whom and when.
abstract: Androgens play a primary role in female physiopathology. The age-related reduction in the production of ovarian and adrenal androgens may significantly affect women's health. The decline of circulating androgens results from a combination of two events: reduced ovarian production and aged-related decline in adrenal androgen synthesis. The relative androgen deficiency in pre- and postmenopausal women may induce impairment of sexual function, libido, well-being, energy and may contribute to reduced cognitive functions. Whether androgen deficiency also affects cardiovascular or bone biology in women during reproductive aging is still controversial. Both in the central nervous system and peripheral tissues, there are multiple ways whereby androgens target their specific actions through a particular tropism of the brain areas that are involved in sexual function, behavior and cognition. Among circulating available androgens that are involved in several domains of sexual response, adrenal androgens seem to be related to some sexual symptoms as well as diminished cognitive function in postmenopausal women. The possibilities of treating low sexual desire/hypoactive sexual desire disorder are multifaceted and should include the combination of both pharmacological treatments able to maximize biological signals that drive the sexual response as well as individualized psychosocial therapies to overcome personal and relational difficulties. Transdermal testosterone has been proved to be effective but the use of additional treatment like oral or vaginal dehydroepiandrosterone is still controversial, despite many evidences support it. The decision to treat premenopausal or postmenopausal women with signs/symptoms of androgen insufficiency is mainly based on the clinical judgment, together with estrogens co-administration and following informed consent related to the unknown long-term risks.
authors.affiliation: Department of Reproductive Medicine and Child Development, Division of Gynecology and Obstetrics, University of Pisa, Via Roma 35, 56100, Pisa, Italy, nicola.pluchino@med.unipi.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Pluchino
authors.forename: Arianna
authors.initials: A
authors.lastname: Carmignani
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cubeddu
authors.forename: Anna
authors.initials: A
authors.lastname: Santoro
authors.forename: Vito
authors.initials: V
authors.lastname: Cela
authors.forename: Tania
authors.initials: T
authors.lastname: Errasti
authors.forename: Tania Errasti
authors.initials: TE
authors.lastname: Alcalà
mesh_terms: D000375:Aging; D000728:Androgens / Q000172:deficiency* / Q000378:metabolism / Q000627:therapeutic use*; D003687:Dehydroepiandrosterone / Q000627:therapeutic use; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D007006:Hypogonadism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D017698:Postmenopause; D017697:Premenopause; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000728:Androgens; D003687:Dehydroepiandrosterone