Gynäkologische Endokrinologie

, Volume 16, Issue 2, pp 123–127 | Cite as

Androgens in postmenopausal women

  • Susan R. Davis


Endogenous androgen production is essential for women’s reproductive function and nonreproductive health. The primary sources of androgens are the ovaries and the adrenal glands. The amount of androgen produced by these sources varies across a woman’s life span. It is well documented that circulating androgen levels decline with age from the middle of the fourth decade of life. This decline appears to affect reproductive capacity and impacts nonreproductive health. This review summarizes what is known about androgen physiology in women, the impact of the age-related decline, and the potential benefits and risks of androgen therapy.


Menopause Androgen receptors Testosterone Postmenopausal hormone replacement therapy Sexual health 

Androgene bei Frauen in der Postmenopause


Die endogene Androgenproduktion ist von grundlegender Bedeutung für die reproduktive Funktion und die nichtreproduktive Gesundheit von Frauen. Primäre Quellen für Androgene sind die Ovarien und Nebennieren. Dabei schwankt die Menge der aus diesen Quellen stammenden Androgene im Lauf des Lebens einer Frau. Gut dokumentiert ist, dass die Werte zirkulierender Androgene ab der Mitte des 4. Lebensjahrzehnts abnehmen. Diese Abnahme scheint die reproduktive Kapazität und die nichtreproduktive Gesundheit zu beeinflussen. In der vorliegenden Übersicht werden sowohl das Wissen über die Physiologie der Androgene bei Frauen als auch der Einfluss der altersbedingten Abnahme der Androgenspiegel sowie mögliche Vorteile und Risiken der Androgentherapie dargelegt.


Menopause Androgenrezeptoren Testosteron Postmenopausale Hormonersatztherapie Sexuelle Gesundheit 


Compliance with ethical guidelines

Conflict of interest

S.R. Davis is an Australian NHMRC Senior Principal Research Fellow. She has received honoraria from Pfizer Australia, Besins Healthcare and Lawley Pharmaceuticals, and research support from Lawley Pharmaceuticals.

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Davis SR, Panjari M, Stanczyk FZ (2011) DHEA replacement for postmenopausal women. J Clin Endocrinol Metab 96(6):1642–1653CrossRefPubMedGoogle Scholar
  2. 2.
    Dunn JF, Nisula BC, Rodboard D (1981) Transport of steroid hormones. Binding of 21 endogenous steroids to both testosterone-binding globulin and cortico-steroid-binding globulin in human plasma. J Clin Endocrinol Metab 53:58–68CrossRefPubMedGoogle Scholar
  3. 3.
    Kang MJ, Lee JS, Kim HY, Jung HW, Lee YA, Lee SH et al (2017) Contributions of CAG repeat length in the androgen receptor gene and androgen profiles to premature pubarche in Korean girls. Endocr J 64(1):91–102CrossRefPubMedGoogle Scholar
  4. 4.
    Vottero A, Capelletti M, Giuliodori S, Viani I, Ziveri M, Neri TM et al (2006) Decreased androgen receptor gene methylation in premature pubarche: a novel pathogenetic mechanism? J Clin Endocrinol Metab 91(3):968–972CrossRefPubMedGoogle Scholar
  5. 5.
    Pretorius E, Africander DJ, Vlok M, Perkins MS, Quanson J, Storbeck KH (2016) 11-Ketotestosterone and 11-ketodihydrotestosterone in castration resistant prostate cancer: potent androgens which can no longer be ignored. PLoS ONE 11(7):e159867CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pretorius E, Arlt W, Storbeck KH (2017) A new dawn for androgens: Novel lessons from 11-oxygenated C19 steroids. Mol Cell Endocrinol 441:76. CrossRefPubMedGoogle Scholar
  7. 7.
    Davison SL, Bell R, Donath S, Montalto JG, Davis SR (2005) Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab 90(7):3847–3853CrossRefPubMedGoogle Scholar
  8. 8.
    Haring R, Hannemann A, John U, Radke D, Nauck M, Wallaschofski H et al (2012) Age-specific reference ranges for serum testosterone and androstenedione concentrations in women measured by liquid chromatography-tandem mass spectrometry. J Clin Endocrinol Metab 97(2):408–415CrossRefPubMedGoogle Scholar
  9. 9.
    van der Stege JG, Groen H, van Zadelhoff SJ, Lambalk CB, Braat DD, van Kasteren YM et al (2008) Decreased androgen concentrations and diminished general and sexual well-being in women with premature ovarian failure. Menopause 15(1):23–31CrossRefPubMedGoogle Scholar
  10. 10.
    Pugeat M, Nader N, Hogeveen K, Raverot G, Dechaud H, Grenot C (2010) Sex hormone-binding globulin gene expression in the liver: drugs and the metabolic syndrome. Mol Cell Endocrinol 316(1):53–59CrossRefPubMedGoogle Scholar
  11. 11.
    Doan HT, Quan LH, Nguyen TT (2017) The effectiveness of transdermal testosterone gel 1 % (androgel) for poor responders undergoing in vitro fertilization. Gynecol Endocrinol 33(12):977–979CrossRefPubMedGoogle Scholar
  12. 12.
    Kim CH, Howles CM, Lee HA (2011) The effect of transdermal testosterone gel pretreatment on controlled ovarian stimulation and IVF outcome in low responders. Fertil Steril 95(2):679–683CrossRefPubMedGoogle Scholar
  13. 13.
    Polyzos NP, Davis SR, Drakopoulos P, Humaidan P, De Geyter C, Vega AG et al (2016) Testosterone for poor ovarian responders: lessons from ovarian physiology. Reprod Sci. PubMedGoogle Scholar
  14. 14.
    Slemenda C, Longcope C, Peacock M, Hui S, Johnston CC (1996) Sex steroids, bone mass, and bone loss. A prospective study of pre-, peri- and postmenopausal women. J Clin Invest 97:14–21CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Rariy CM, Ratcliffe SJ, Weinstein R, Bhasin S, Blackman MR, Cauley JA et al (2011) Higher serum free testosterone concentration in older women is associated with greater bone mineral density, lean body mass, and total fat mass: the cardiovascular health study. J Clin Endocrinol Metab 96(4):989–996CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Lee JS, LaCroix AZ, Wu L, Cauley JA, Jackson RD, Kooperberg C et al (2008) Associations of serum sex hormone-binding globulin and sex hormone concentrations with hip fracture risk in postmenopausal women. J Clin Endocrinol Metab 93(5):1796–1803CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Davis SR, McCloud PI, Strauss BJG, Burger HG (1995) Testosterone enhances estradiol’s effects on postmenopausal bone density and sexuality. Maturitas 21:227–236CrossRefPubMedGoogle Scholar
  18. 18.
    Miller KK, Biller BM, Beauregard C, Lipman JG, Jones J, Schoenfeld D et al (2006) Effects of testosterone replacement in androgen-deficient women with hypopituitarism: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab 91(5):1683–1690CrossRefPubMedGoogle Scholar
  19. 19.
    Jones RD, Jones HT, Channer KS (2004) The influence of testosterone upon vascular reactivity. Eur J Endocrinol 151(1):29–37CrossRefPubMedGoogle Scholar
  20. 20.
    Davis SR, Wahlin-Jacobsen S (2015) Testosterone in women—the clinical significance. Lancet Diabetes Endocrinol 3(12):980–992CrossRefPubMedGoogle Scholar
  21. 21.
    Spoletini I, Vitale C, Pelliccia F, Fossati C, Rosano GM (2014) Androgens and cardiovascular disease in postmenopausal women: a systematic review. Climacteric 17(6):625–634CrossRefPubMedGoogle Scholar
  22. 22.
    Aleman A, Bronk E, Kessels RP, Koppeschaar HP, van Honk J (2004) A single administration of testosterone improves visuospatial ability in young women. Psychoneuroendocrinology 29(5):612–617CrossRefPubMedGoogle Scholar
  23. 23.
    Postma A, Meyer G, Tuiten A, van Honk J, Kessels RP, Thijssen J (2000) Effects of testosterone administration on selective aspects of object-location memory in healthy young women. Psychoneuroendocrinology 25(6):563–575CrossRefPubMedGoogle Scholar
  24. 24.
    Drake EB, Henderson VW, Stanczyk FZ, McCleary CA, Brown WS, Smith CA et al (2000) Associations between circulating sex steroid hormones and cognition in normal elderly women. Neurology 54(3):599–603CrossRefPubMedGoogle Scholar
  25. 25.
    Wolf OT, Kirschbaum C (2002) Endogenous estradiol and testosterone levels are associated with cognitive performance in older women and men. Horm Behav 41(3):259CrossRefPubMedGoogle Scholar
  26. 26.
    Shah SM, Bell RJ, Savage G, Goldstat R, Papalia MA, Kulkarni J et al (2006) Testosterone aromatization and cognition in women: a randomized placebo controlled trial. Menopause 13(4):600–608CrossRefPubMedGoogle Scholar
  27. 27.
    Davis SR, Davison SL, Gavrilescu M, Searle K, Gogos A, Rossell SL et al (2014) Effects of testosterone on visuospatial function and verbal fluency in postmenopausal women: results from a functional magnetic resonance imaging pilot study. Menopause 21(4):410–414PubMedGoogle Scholar
  28. 28.
    Davis SR, Jane F, Robinson PJ, Davison SL, Worsley R, Maruff P et al (2014) Transdermal testosterone improves verbal learning and memory in postmenopausal women not on oestrogen therapy. Clin Endocrinol (oxf) 81(4):621–628CrossRefGoogle Scholar
  29. 29.
    Wahlin-Jacobsen S, Pedersen AT, Kristensen E, Laessoe NC, Lundqvist M, Cohen AS et al (2015) Is there a correlation between androgens and sexual desire in women? J Sex Med 12(2):358. CrossRefPubMedGoogle Scholar
  30. 30.
    Randolph JF Jr., Zheng H, Avis NE, Greendale GA, Harlow SD (2015) Masturbation frequency and sexual function domains are associated with serum reproductive hormone levels across the menopausal transition. J Clin Endocrinol Metab 100(1):258–266CrossRefPubMedGoogle Scholar
  31. 31.
    Davis SR, Davison SL, Donath S, Bell RJ (2005) Circulating androgen levels and self-reported sexual function in women. JAMA 294(1):91–96CrossRefPubMedGoogle Scholar
  32. 32.
    Apperloo M, Midden M, van der Stege J, Wouda J, Hoek A, Weijmar Schultz W (2006) Vaginal application of testosterone: a study on pharmacokinetics and the sexual response in healthy volunteers. J Sex Med 3(3):541–549CrossRefPubMedGoogle Scholar
  33. 33.
    Raghunandan C, Agrawal S, Dubey P, Choudhury M, Jain A (2010) A comparative study of the effects of local estrogen with or without local testosterone on vulvovaginal and sexual dysfunction in postmenopausal women. J Sex Med 7(3):1284–1290CrossRefPubMedGoogle Scholar
  34. 34.
    Fernandes T, Costa-Paiva LH, Pinto-Neto AM (2014) Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on sexual function in postmenopausal women: a randomized controlled trial. J Sex Med 11(5):1262–1270CrossRefPubMedGoogle Scholar
  35. 35.
    Witherby S, Johnson J, Demers L, Mount S, Littenberg B, Maclean CD et al (2011) Topical testosterone for breast cancer patients with vaginal atrophy related to aromatase inhibitors: a phase I/II study. Oncologist 16(4):424–431CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Dahir M, Travers-Gustafson D (2014) Breast cancer, aromatase inhibitor therapy, and sexual functioning: a pilot study of the effects of vaginal testosterone therapy. Sex Med 2(1):8–15CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Melisko ME, Goldman ME, Hwang J, De Luca A, Fang S, Esserman LJ et al (2017) Vaginal testosterone cream vs estradiol vaginal ring for vaginal dryness or decreased libido in women receiving aromatase inhibitors for early-stage breast cancer: a randomized clinical trial. Jama Oncol 3(3):313–319CrossRefPubMedGoogle Scholar
  38. 38.
    Bell RJ, Rizvi F, Islam MR, Davis SR (2018) A systematic review of intra-vaginal testosterone for the treatment of vulvo-vaginal atrophy. Menopause. PubMedGoogle Scholar
  39. 39.
    McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E et al (2016) Definitions of sexual dysfunctions in women and men: a consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med 13(2):135–143CrossRefPubMedGoogle Scholar
  40. 40.
    Davis SR, Worsley R, Miller KK, Parish SJ, Santoro N (2016) Androgens and female sexual function and dysfunction—findings from the fourth international consultation of sexual medicine. J Sex Med 13(2):168–178CrossRefPubMedGoogle Scholar
  41. 41.
    Wierman ME, Arlt W, Basson R, Davis SR, Miller KK, Murad MH et al (2014) Androgen therapy in women: a reappraisal: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99(10):3489–3510CrossRefPubMedGoogle Scholar
  42. 42.
    Worsley R, Bell RJ, Gartoulla P, Davis SR (2017) Prevalence and predictors of low sexual desire, sexually related personal distress, and hypoactive sexual desire dysfunction in a community-based sample of Midlife women. J Sex Med 14(5):675–686CrossRefPubMedGoogle Scholar
  43. 43.
    Zeleke BM, Bell RJ, Billah B, Davis SR (2017) Hypoactive sexual desire dysfunction in community-dwelling older women. Menopause 24(4):391–399CrossRefPubMedGoogle Scholar
  44. 44.
    Davis SR, Braunstein GD (2012) Efficacy and safety of testosterone in the management of hypoactive sexual desire disorder in postmenopausal women. J Sex Med 9(4):1134–1148CrossRefPubMedGoogle Scholar
  45. 45.
    Davis SR, Moreau M, Kroll R, Bouchard C, Panay N, Gass M et al (2008) Testosterone for low libido in menopausal women not taking estrogen therapy. N Eng J Med 359:2005–2017CrossRefGoogle Scholar
  46. 46.
    Shifren J, Davis SR, Moreau M, Waldbaum A, Bouchard C, DeRogatis L et al (2006) Testosterone patch for the treatment of hypoactive sexual desire disorder in naturally menopausal women: results from the INTIMATE NM1 study. Menopause 13(5):770–779CrossRefPubMedGoogle Scholar
  47. 47.
    de Villiers TJ, Pines A, Panay N, Gambacciani M, Archer DF, Baber RJ et al (2013) Updated 2013 international menopause society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric 16(3):316–337CrossRefPubMedGoogle Scholar
  48. 48.
    Nijland EA, Weijmar Schultz WC, Nathorst-Boos J, Helmond FA, Van Lunsen RH, Palacios S et al (2008) Tibolone and transdermal E2/NETA for the treatment of female sexual dysfunction in naturally menopausal women: results of a randomized active-controlled trial. J Sex Med 5(3):646–656CrossRefPubMedGoogle Scholar
  49. 49.
    Glaser R, Kalantaridou S, Dimitrakakis C (2013) Testosterone implants in women: pharmacological dosing for a physiologic effect. Maturitas 74(2):179–184CrossRefPubMedGoogle Scholar
  50. 50.
    Fooladi E, Reuter SE, Bell RJ, Robinson PJ, Davis SR (2015) Pharmacokinetics of a transdermal testosterone cream in healthy postmenopausal women. Menopause 22(1):44–49CrossRefPubMedGoogle Scholar
  51. 51.
    Ali A, Berens P, Siddiqui G, Ali V (2012) Nipple and areolar hyperpigmentation secondary to the use of estradiol spray on the ipsilateral forearm skin: a report of two cases. J Womens Health (larchmt) 21(3):363–365CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia

Personalised recommendations