Effect of age on plasma androstenedione concentration in oophorectomized women

The varied nature of women's sexuality: unresolved issues and a theoretical approach

During the 20th century there were clear indications that the socio-cultural suppression of women's sexuality had lessened, revealing a marked variability of women's sexual expression. In this article we review the recent literature to explore explanations for this variability. It is clear that we know little about the nature of sexual desire, and in particular, what it is that is desired. There is also now substantial evidence that vaginal response, as measured by vaginal pulse amplitude, is a relatively automatic response to perception of sexual stimuli, regardless of whether these stimuli are perceived positively or result in subjective arousal. This is considered as a possible mechanism that allows vaginal intercourse without pain, even when the woman is not sexually aroused. The roles of androgens and estrogen in women's sexuality remain uncertain. The evidence is, however, consistent with there being a testosterone-dependent component of women's sexuality that is more important for some women than others. Finally, a new theoretical model is presented that aims to resolve these uncertainties and that proposes different types of women's sexuality. Once we have a better understanding of "normal" female sexuality, in its various forms, our ability to develop effective treatments for women's sexual problems should improve.

SHOULD WE CONSIDER AN ACCEPTABLE DRINKING LEVEL SPECIFICALLY FOR POSTMENOPAUSAL WOMEN? PRELIMINARY FINDINGS FROM THE POSTMENOPAUSAL HEALTH DISPARITIES STUDY

AIMS

There are substantial neuroendocrine differences between postmenopausal (PMP) women and women with cyclic ovarian function; thus there are differences in hormonal responses to 'acceptable' levels of drinking, i.e. 7 total weekly drinks (TWD). The aim is to evaluate whether alcoholic beverage consumption for PMP women should be the same for all women, as is currently the case, or different from that for women with cyclic ovarian function.

METHODS

Carefully collected and cross-checked current drinking data in 318 PMP women from a spectrum of racial and ethnic groups have been analysed to determine if a plateau in estradiol (E2) levels at a particular alcohol consumption level other than 7 TWD can be identified as the drinking level above which no additional benefit in E2 levels occurs.

RESULTS

Levels of E2 are significantly different among abstainers and among drinkers within all racial and ethnic groups, with the disturbing exception of black PMP women. Although there are significant differences among racial and ethnic groups in the proportions of women who drink, there are no differences in TWD consumed during the previous month. Between < or =5 TWD and < or =6 TWD, a plateau in the correlation of E2 with increasing drinks/week occurs, and the range of the unstandardized multiple regression coefficient +/- the standard error do not overlap between these same two drinking levels (P < 0.05).

CONCLUSIONS

Consideration should be given to lowering the acceptable level of drinking for PMP women 5 TWD. Additional studies in which sample sizes for each minority racial and ethnic are larger need to be performed in the future.

Perturbations of hypothalamic-pituitary-gonadal (HPG) axis and adrenal androgen (AA) functions in rheumatoid arthritis

The available evidence reviewed does not allow definitive response to the question of a primary versus secondary role of sex hormone perturbations in RA. However, this conclusion should not be discouraging in view of the relatively recent focus upon this facet of the physiopathogenesis of RA and the enormous complexities of sex hormone biology and this disease. Specifically, data on the incidence of RA as well as life cycle changes in serum androgenic-anabolic (A-A) and sex hormone levels suggest important risk correlations. Furthermore, HLA-susceptibility markers for RA, gender, menopause and older age are all factors which significantly relate to the risk of developing RA and each has been shown to associate with sex hormone status. Whether or not HPG-AA hormonal status may modulate RA risk (or its course) primarily and independently or merely be predictive markers of other biological mechanisms was critically considered and requires further study. Sex hormone influences on cellular and humoral immunological reactivity and vascular pathogenetic mechanisms in RA were summarized. Androgens generally suppress immunoreactivity and cartilage responses to inflammation-mediated injury processes and may enhance synovial macrophage-like lining cell apoptosis. Oestrogens generally enhance immunoreactivity, offer some protection to inflammation-mediated cartilage damage (but less than androgens) and may inhibit apoptosis in certain in vitro cell models. Scant information is available on the balance of sex hormones (and glucocorticoids) in RA or its presumed pathogenetic mechanisms. Data were reviewed which support the concept of a spectrum of androgenicity in the normal population, particularly among women. A simplified schema of trophic and tropic steroidogenic mechanisms was proposed which could influence androgenic-anabolic (A-A) status and might relate to RA. Serum concentrations of DHAS (mumol/l), T (nmol/l) and O2 (pmol/l) span several orders of magnitude in normal physiology. The effects of alterations in the individual levels of these sex hormones and deviations from their normal physiological balance are not well understood. Critical attention to their biological functions is needed in RA as well as in health and disease generally. Such focused clinical and experimental investigations of HPG-AA functions promise to clarify the complex physiopathology of RA and contribute to its improved long-term management.

The influence of cyclosporine A therapy on sex hormone levels in pre- and post-menopausal women with primary biliary cirrhosis

The mechanism underlying sex hormone disturbances in post-menopausal women with primary biliary cirrhosis is unclear, but these alterations may occur as a consequence of liver disease. As cyclosporine may have some therapeutic potential is this condition, we have evaluated short-term alterations in plasma sex hormone levels in 11 pre- and 19 post-menopausal women with primary biliary cirrhosis following randomisation to cyclosporine A or placebo therapy. Baseline sex hormone binding globulin levels were markedly depressed in all pre-menopausal women but were elevated for the post-menopausal group when compared to standard reference ranges. Testosterone and dihydrotestosterone levels were low or markedly depressed in both patient groups. Androstendione concentrations tended to be higher than the normal range in the post-menopausal group. Oestradiol levels were within the normal range for the pre-menopausal group but were relatively higher in the post-menopausal group than in other normal post-menopausal women. Cyclosporine A therapy resulted in significant decreases in sex hormone binding globulin levels (26.6 +/- 5.0 to 16.2 +/- 4.6 nmol/l; p < 0.05) in the premenopausal group and reduction in total (336 +/- 163 to 140 +/- 132 pmol/l; p < 0.01) and free (6 +/- 5 to 2 +/- 3 pmol/l; p < 0.05) oestradiol levels in the post-menopausal group at 6 months. There were no significant alterations in other hormonal parameters. No temporal changes occurred in the placebo group. Cyclosporine A therefore induces significant but variable sex hormone changes in both pre- and post-menopausal women with primary biliary cirrhosis.

Spinal osteoporosis in men

In 94 men with crush fracture, 40 were found to have primary osteoporosis. Cross-sectional measurements of a number of variables related to bone in these 40 patients were compared to the values in various groups of healthy men aged 20-96. In healthy men, metacarpal and femoral cortical area/total area, bone volume, osteoid surfaces, seam and trabecular width, plasma dihydroepiandrosterone and estrone, and radiocalcium absorption fell with age, whereas eroded surfaces, trabecular number, urine hydroxyproline and calcium/creatinine ratios, plasma alkaline phosphatase, estradiol, androstenedione, cortisol and testosterone remained constant with age. As compared with healthy men, men with primary osteoporosis had reduced femoral cortical area/total area (P less than 0.05), and Singh grade (P less than 0.001) and in seven there was a history of forearm or femoral fracture. On iliac crest biopsy, bone volume (P less than 0.001) and trabecular number (P less than 0.01) were decreased. Plasma alkaline phosphatase (P less than 0.02) was increased but urine hydroxyproline and calcium excretion were not significantly raised. Calcium balance was negative due to failure of absorption to match urinary calcium loss and radiocalcium absorption (P less than 0.01) and plasma 1,25-dihydroxyvitamin D (P less than 0.05) were reduced.

Effects of moderate consumption of alcoholic beverages on endocrine function in postmenopausal women. Bases for hypotheses

That alcoholic beverage consumption has not yet received attention as a variable that might influence the estrogenization of postmenopausal women is discussed within the context of the growing proportion of postmenopausal women in the population, their disease risk vis-à-vis estrogenization, and survey findings that report that the majority of postmenopausal women use alcoholic beverages to at least some degree. The available literature is reviewed concerning the effects of acute or chronic ethanol administration, alcoholic beverage consumption, or the administration of phytoestrogen-containing congeners of bourbon on the endocrine status of postmenopausal women or relevant animal models. The basic components of postmenopausal endocrine function and the factors known to affect endocrine status are presented. The importance of incorporating known endocrine-modulating factors into the design of future studies so as to maximize the detection of alcohol effects in postmenopausal women is emphasized.

The role of serum concentrations of sex steroids and bone turnover in the development and occurrence of postmenopausal osteoporosis

It has been debated whether postmenopausal osteoporosis is characterized by high or low bone turnover and whether circulating levels of sex steroids contribute to the occurrence of osteoporotic fractures. We examined 154 70-year-old women with or without osteoporotic fractures, and 178 early postmenopausal women with a "rapid" or a "slow" bone loss. In all participants, we determined markers of bone formation (serum alkaline phosphatase (AP) and serum bone Gla protein (BGP)), markers of bone resorption (fasting urinary calcium/creatinine (FU Ca/Cr) and hydroxyproline/creatinine (FU Hpr/Cr)), and serum estrone (E1), estradiol (E2), androstenedione (A), and fat mass. The 70-year-old women with osteoporotic fractures had significantly elevated AP (P less than 0.001), BGP (P less than 0.001), and FU Hpr/Cr (P less than 0.001) compared with the group without fractures. In the group of early postmenopausal women, the "rapid" bone losers had significantly increased FU Hpr/Cr (P less than 0.001) and FU Ca/Cr (P less than 0.001). E1, E2, A, and the fat mass did not differ in the groups with and without osteoporotic fractures, whereas the "rapid" bone losers had significantly lower E1 (P less than 0.05), E2 (P less than 0.05), and fat mass (P less than 0.01) than the "slow" bone losers. It is concluded that patients with manifest osteoporosis and early postmenopausal women with a rapid bone loss have increased biochemical markers of bone turnover. Moreover, the present study demonstrates that early postmenopausal women with an "excessive" bone loss have significantly decreased serum estrogens, whereas it is not possible to detect low estrogens in women with osteoporotic fractures.

The effects of age and body composition on circulating serum oestrogens and androstenedione after the menopause

Circulating levels of oestrone, oestradiol and androstenedione were measured in two large groups of postmenopausal women, in one group the women were between 46 and 56 years of age and in the second, older group they were 70 years of age. In addition the fat mass was calculated from the height, weight and age of the women. Serum concentrations of both oestrogens did not change with age, whereas the serum androstenedione concentration decreased significantly. A change in body composition included decreased height and increased fat mass in the older group. Serum concentrations of both oestrogens correlated significantly with the fat mass and serum androstenedione as well as with each other. From the correlation analysis it may be concluded that the conversion rate of androstenedione to oestrone, and of oestrone to oestradiol, increases with age, which presumably explains the unchanged concentrations of the circulating oestrogens in relation to postmenopausal age, although the precursor decreases during the same period.

Effects of age on the urinary excretion of total and non-dialyzable hydroxyproline

This study was carried out in order to investigate the effects of age on the urinary excretion of total and non-dialyzable hydroxyproline (OHPr) in normal subjects. We found that total urinary OHPr was negatively correlated with age but, by means of partial regression analysis, no correlation was found after correction for changes in creatinine clearance; on the contrary, non-dialyzable OHPr showed a statistically significant negative correlation with age (r = -0.56) even when creatinine clearance was held constant (p less than 0.05). A highly significant direct correlation was found between total and non-dialyzable OHPr in the whole group (r = 0.54) and when only premenopausal women and men under 60 years of age were considered (r = 0.51). No correlation was found when postmenopausal women and men more than 60-year-old were taken into account. Our data appear to indicate that also the decrease in osteogenetic activity is responsible for the physiological late involutional bone loss; they also show the importance of hormonal changes in inducing an uncoupling between bone formation and resorption.

Production rates of androgens and oestrogens in post-menopausal women

The production rate (PR) values of delta 4-androstenedione (A), testosterone (T), oestrone (E1) and oestradiol (E2) have been determined in a large group of post-menopausal women following constant infusions of radiolabelled hormones and radioimmunoassay of endogenous steroid concentration. The mean +/- SE age was 64 +/- 2 yr, ranging from 46 to 91 yr and the mean +/- SE weight was 144 +/- 4 lb. When the PR values were related to age by linear regression analysis no significant correlation could be found for PRA, PRT or PRE1 and the age of the subjects. There was, however, a significant correlation between PRE2 and age. There was a significant correlation between the PR values for each of the four steroids and the weights and body surface areas of the subjects. In addition, PRA correlated directly with both PRT and PRE1 in these subjects in which both PR values were measured. The PR values for each steroid were significantly smaller in the post-menopausal women compared to the mean PR values of a large group of pre-menopausal women. We conclude that age, per se, does not appear to influence the PR values for A, T and E1 but does for E2. The subjects weight, however, has a major influence for the PR values of all four steroids.