Effect of postmenopausal estrogen replacement on circulating androgens

Peter R. Casson, Karen E. Elkind-Hirsch, John E. Buster, Peter J Hornsby, Sandra A. Carson, Michael C. Snabes

Research output: Contribution to journalArticle

126 Citations (Scopus)

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 μg/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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)995-998
Number of pages4
JournalObstetrics and Gynecology
Volume90
Issue number6
DOIs
StatePublished - Dec 1997
Externally publishedYes

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Estrogen Replacement Therapy
Dehydroepiandrosterone Sulfate
Androgens
Testosterone
Sex Hormone-Binding Globulin
Serum
Estradiol
Estrogens
Dehydroepiandrosterone
Cross-Over Studies
Fasting
Placebos

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Casson, P. R., Elkind-Hirsch, K. E., Buster, J. E., Hornsby, P. J., Carson, S. A., & Snabes, M. C. (1997). Effect of postmenopausal estrogen replacement on circulating androgens. Obstetrics and Gynecology, 90(6), 995-998. https://doi.org/10.1016/S0029-7844(97)00538-3

Effect of postmenopausal estrogen replacement on circulating androgens. / Casson, Peter R.; Elkind-Hirsch, Karen E.; Buster, John E.; Hornsby, Peter J; Carson, Sandra A.; Snabes, Michael C.

In: Obstetrics and Gynecology, Vol. 90, No. 6, 12.1997, p. 995-998.

Research output: Contribution to journalArticle

Casson, PR, Elkind-Hirsch, KE, Buster, JE, Hornsby, PJ, Carson, SA & Snabes, MC 1997, 'Effect of postmenopausal estrogen replacement on circulating androgens', Obstetrics and Gynecology, vol. 90, no. 6, pp. 995-998. https://doi.org/10.1016/S0029-7844(97)00538-3
Casson PR, Elkind-Hirsch KE, Buster JE, Hornsby PJ, Carson SA, Snabes MC. Effect of postmenopausal estrogen replacement on circulating androgens. Obstetrics and Gynecology. 1997 Dec;90(6):995-998. https://doi.org/10.1016/S0029-7844(97)00538-3
Casson, Peter R. ; Elkind-Hirsch, Karen E. ; Buster, John E. ; Hornsby, Peter J ; Carson, Sandra A. ; Snabes, Michael C. / Effect of postmenopausal estrogen replacement on circulating androgens. In: Obstetrics and Gynecology. 1997 ; Vol. 90, No. 6. pp. 995-998.
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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 μg/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). Conclusion: 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.",
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AU - Snabes, Michael C.

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