Magazine article Clinical Psychiatry News

Paper Defines Female Androgen Insufficiency. (Affordable Assay Needed)

Magazine article Clinical Psychiatry News

Paper Defines Female Androgen Insufficiency. (Affordable Assay Needed)

Article excerpt

Los ANGELES--A newly published consensus statement on female androgen insufficiency offers a working definition of the condition and an algorithm for its management.

It also emphasizes an urgent need for development of a practical, affordable assay for assessment of bioavailable testosterone in women. "Current androgen assays are unsatisfactory primarily because of their lack of [either] sensitivity or reliability at the lower ranges of normal," the document states (Fertil. Steril. 77[4]:66065, 2002).

Dr. Irwin Goldstein, director of the Center for Sexual Medicine and professor of urology at Boston University hailed the new guidelines as a "bible," offering perspective on a topic that has long been underappreciated. His remarks came during a session on female sexuality at the annual meeting of the American College of Obstetricians and Gynecologists.

A consensus panel member, Dr. Goldstein said that the document may specifically spur interest among physicians in treating the 60 million women in America who have sexual dysfunction. To date, less than 5% of ob.gyns., for example, have indicated an enthusiasm about getting involved in the field, perhaps because it has been marked by a lack of good research to guide their practice.

"Historically, androgens have been identified with masculinity or male sexual function, which has undoubtedly contributed to a lack of recognition of androgen effects in women," stated the consensus statement by 19 panelists who attended a conference in June 2001 at the Robert Wood Johnson Medical School in Piscataway, N.J.

"In fact," the statement continued, "androgens are necessary not only for the development of reproductive function and hormonal homeostasis in women, but they also represent the immediate precursors for the biosynthesis of estrogen. Androgens affect sexual desire, bone density, muscle mass and strength, adipose tissue distribution, mood, energy and psychological well-being."

To help guide clinicians, the panel defined androgen insufficiency in women as a pattern of clinical symptoms in the presence of decreased bioavailable testosterone and normal estrogen status.

Symptoms must be present for a diagnosis and can include a diminished sense of well-being or dysphoric mood; persistent, unexplained fatigue; and sexual function changes, including decreases in libido, sexual receptivity, and pleasure. Other potential symptoms may be bone loss, decreased muscle strength, and memory or cognition declines.

Since these symptoms can be signs of other diseases, including depression, they are not sufficient for a diagnosis of female androgen insufficiency until other conditions have been ruled out and two other conditions are met:

* There is evidence of adequate estrogen, such as normal cycles in premenopausal women or estrogen replacement therapy in postmenopausal women.

* The patient has free testosterone values at or below the lowest quartile of the normal range for her reproductive age.

Since sensitive assays and absolute threshold values of androgens have not been established for women, the panel offered the lowest-quartile cutoff as a "clinically useful, albeit arbitrary, criterion for establishing a diagnosis."

Androgen assays remain a conundrum, the panel acknowledged. …

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