Androgen deficiency

Androgen deficiency also known as hypoandrogenism and androgen deficiency syndrome, is a medical condition characterized by not enough androgenic activity in the body.

Signs and symptoms

Symptoms of the condition in males consist of loss of libido, impotence, infertility, shrinkage of the testicles, penis, and prostate, diminished masculinization (e.g., decreased facial and body hair growth), low muscle mass, anxiety, depression, fatigue, hot flashes, insomnia, headaches, and osteoporosis. In addition, symptoms of hyperestrogenism, such as gynecomastia and feminization, may be concurrently present in males. In females, hypoandrogenism generally presents predominantly as psychological symptoms such as loss of libido, lowered mood, blunted motivation, flat affect, reduced energy, but may also present with other symptoms such as decreased pubic hair growth, vaginal vasocongestion (which can result in cramps), vasomotor symptoms (e.g., hot flashes and palpitations), insomnia, headaches, and reduced bone and muscle mass.^[1][2][3] Symptoms of hypoestrogenism may be present in both sexes in cases of severe androgen deficiency (as estrogens are synthesized from androgens).

Causes

Hypoandrogenism is caused primarily by either dysfunction, failure, or absence of the gonads (hypergonadotropic) or impairment of the hypothalamus or pituitary gland (hypogonadotropic), which in turn can be caused by a multitude of different stimuli, including genetic conditions (e.g., GnRH/gonadotropin insensitivity and enzymatic defects of steroidogenesis), tumors, trauma, surgery, autoimmunity, radiation, infections, toxins, drugs, and many others. Alternatively, it may be the result of conditions such as androgen insensitivity syndrome or hyperestrogenism. More simply, old age may also be a factor in the development of hypoandrogenism, as androgen levels decline with age.

Diagnosis

It is recommended that androgen deficiency not be diagnosed in women who are healthy.^[4]

Treatments

Treatment may consist of hormone replacement therapy with androgens in either sex. Alternatively, gonadotropin-releasing hormone (GnRH)/GnRH agonists or gonadotropins may be given (in the case of hypogonadotropic hypoandrogenism). The Food and Drug Administration (FDA) stated in 2015 that neither the benefits nor the safety of testosterone have been established for low testosterone levels due to aging.^[5] The FDA has required that testosterone pharmaceutical labels include warning information about the possibility of an increased risk of heart attacks and stroke.^[5]

See also

• Hypogonadism
• Hyperandrogenism
• Hypoestrogenism
• Hypergonadism
• Hyperestrogenism
• Androgen

References

1. Jakiel G, Baran A (2005). "[Androgen deficiency in women]". Endokrynologia Polska (in Polish) 56 (6): 1016–20. PMID 16821229.
2. Bachmann GA (April 2002). "The hypoandrogenic woman: pathophysiologic overview". Fertility and Sterility. 77 Suppl 4: S72–6. doi:10.1016/S0015-0282(02)03003-0. PMID 12007907.
3. William J. Bremner (27 May 2003). Androgens in Health and Disease. Humana Press. pp. 365–379. ISBN 978-1-58829-029-8. Retrieved 11 June 2012.
4. Wierman, ME; Arlt, W; Basson, R; Davis, SR; Miller, KK; Murad, MH; Rosner, W; Santoro, N (Oct 2014). "Androgen therapy in women: a reappraisal: an endocrine society clinical practice guideline.". The Journal of Clinical Endocrinology and Metabolism 99 (10): 3489–510. doi:10.1210/jc.2014-2260. PMID 25279570.
5. Staff (3 March 2015). "Testosterone Products: Drug Safety Communication - FDA Cautions About Using Testosterone Products for Low Testosterone Due to Aging; Requires Labeling Change to Inform of Possible Increased Risk of Heart Attack And Stroke". FDA. Retrieved 5 March 2015.