Gonadotropin-releasing hormone-induced changes in testosterone secretion in normal women**Supported by the National Institutes of Health grants R01 HD 18967-02 (M.R.S.), P50 HD 12629-07 (W.J.B.), RO1 HD 12625-08 (R.A.S.), Clinical Research Center grant RR-37, and by the Veterans Administration

Sex hormone-binding globulin and androgen levels in immigrant and British-born premenopausal British Pakistani women: Evidence of early life influences?

In women, raised insulin levels are associated with low sex hormone-binding globulin (SHBG) and high androgen levels, which are in turn linked to infertility. Since insulin resistance and hyperinsulinemia are major health problems for South Asians living in Western countries, we predicted that British Pakistani women would have low SHBG and raised androgen levels compared to European women. Given low birth weights in Pakistan, and known links between low birth weight and insulin resistance in later life, we also predicted that immigrant women born in Pakistan would have lower levels of SHBG and higher levels of androgens than British-born British Pakistani women. We assessed SHBG, testosterone, and the free androgen index (FAI) from a single serum sample taken on days 9-11 of the menstrual cycle from 20-40-year-old women living in the UK: 30 immigrants from Pakistan, 30 British-born British Pakistani women, and 25 British-born women of European origin. Age-adjusted analyses showed no significant differences in SHBG, testosterone, or FAI between British-born Pakistani and European-origin women. However, immigrant British Pakistani women had a significantly higher FAI than British-born British Pakistani women. Adjustment for body mass index, waist-to-hip ratio, and smoking status did not affect these results, but further adjustment for height, a marker of early environment, reduced the P-value for the difference in FAI between immigrant and British-born British Pakistani women to below significance. It is possible that the poorer early environment of immigrant British Pakistani women was at least partially responsible for their relatively high levels of free androgens.

Cyclic and individualized administration of gonadotropin-releasing hormone agonists plus progestogens: an alternative protocol for contraception

Twenty-one women presenting with different diseases, with absolute or relative contraindications to hormonal contraception or the use of intrauterine devices, received 300-600 micrograms/day buserelin intranasally from the 1st to the 21st day, and 5 mg/day norethisterone acetate orally from the 16th to the 23rd day of the cycle for a total of 245 cycles. Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol and testosterone were determined on days 3-5 and 13-15 of the cycle, while progesterone determinations and ovarian sonography were performed during the second half of the cycle. According to progesterone values, 92.7% of the treatment cycles were anovulatory, while in one cycle pregnancy was detected (0.4%). Values of serum LH, FSH and estradiol were low, and in most of the cycles ovarian follicular development was limited to follicles < or = 11 mm. In 21 treatment cycles (9%), statistically significant increases in FSH (p < 0.0001) and LH (p < 0.02), as well as ovarian proliferation to preovulatory follicles or luteinized follicles, were found. It appears that in spite of the high cost of medication and monitoring of patients, this regimen could be useful as an alternative in cases where other forms of contraception are contraindicated or have failed.