August 31, 2016
Elevated Androgen Levels
Observed in Perimenopausal Women

Conventional wisdom suggests that all hormones decrease after a woman goes through menopause. Signs and symptoms such as hot flashes and night sweats, bone loss, changes in lipid profiles, and reduction of insulin sensitivity are well documented in the scientific literature and associated with changes in estradiol. Additionally, testosterone and DHEA are known to gradually decrease with age, although recent research suggests transient increases may be seen during the menopausal transition.

In reproductive women, production of testosterone is shared between the ovaries and adrenal glands and accounts for one third of testosterone in circulation. The remaining two thirds comes from peripheral conversion of androgen precursor steroids (DHEA and androstenedione) to testosterone in non-steroid producing tissues.

In menopausal women, these ratios change as a result of the decline of the ovarian production of androstenedione, at which point the adrenal glands become the primary source of this precursor. Consequently there is a decrease in the rate of peripheral conversion of androstenedione to testosterone. However, ovarian production of testosterone remains fairly stable. Many studies have reported a gradual decrease in testosterone between the ages of 15 and 60 years; however, newer research indicates transient increases in androgens may be observed.

One study, conducted by the University of Michigan School of Public Health, revealed testosterone levels actually rise around the time of the final menstrual period. This data was acquired over a 15 year period in 629 women enrolled in the Michigan Bone Health and Metabolism study. Researchers concluded that as a result of the decrease in sex hormone binding globulin (SHBG), the carrier protein for testosterone, there is a positive change in testosterone levels. This transient increase was observed in women between the ages of 43 and 50, or until the final menstrual period, thereafter returning to a decreased level. This study also reported a transient increase in DHEA around the menopausal transition.

This information validates results of elevated androgens often seen in perimenopausal women with Labrix testing. Often, providers call Labrix with questions regarding elevated testosterone and/or DHEA levels in their perimenopausal patients. While elevated androgen levels are considered an early indicator of metabolic syndrome, this research suggests that physiology alone may dictate these elevations in perimenopausal women and may be independent of other sequelae associated with metabolic syndrome. Researchers suggest elevations in androgens may play an important role during the menopausal transition for bone, metabolic, psychological and sexual function.

Of course every woman’s physiology is different, and this transient period may start earlier or later, and may last for an indeterminate period of time. In any case, metabolic syndrome will need to be ruled out anytime androgenic increases are found.

For more information on metabolic syndrome, see the Labrix handout: Treating Insulin Resistance and Metabolic Syndrome

References:
  • Yasui T, Matsui S, Tani A, Kunimi K, Yamamoto S, Irahara M. Androgen in postmenopausal women. J Med Invest. 2012;59(1-2):12-27.
  • Sowers MF, Zheng H, Mcconnell D, Nan B, Karvonen-gutierrez CA, Randolph JF. Testosterone, sex hormone-binding globulin and free androgen index among adult women: chronological and ovarian aging. Hum Reprod. 2009;24(9):2276-85.
  • Cobin RH, Futterweit W, Ginzburg SB, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocr Pract. 2006;12(3):315-37.


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