A greater waist circumference was associated with higher testosterone concentrations cross-sectionally. Cross-sectional regression models considered smoking, hormone use, oophorectomy, fat mass, lean body mass, and waist circumference simultaneously. The correlations between smoking, fat mass, hormone use, and oophorectomy and total testosterone remained statistically significant, while lean body mass and waist circumference were no longer significantly correlated. We also evaluated the association of testosterone concentrations over time in longitudinal models considering body composition, smoking behavior, hormone use, and reproductive surgery status table 5.
Smoking behavior and increasing body mass index were each associated with increasing testosterone concentrations over time, whereas hysterectomy with oophorectomy was associated with a decline in testosterone concentrations over time. These relations were consistent whether the entire population was considered table 5 , panel A or whether the women with the highest 5 percent of body composition were excluded from analysis table 5 , panel B.
Likewise, the same variables remained important when the data from women with the highest 5 percent of testosterone concentration table 5 , panel C were excluded in the event that they might have undiagnosed polycystic ovary syndrome.
In this population-based study, smoking behavior and measures of body composition were associated with increased serum testosterone concentrations. There were no significant associations with other lifestyle variables representing alcohol consumption, physical activity, and intake of energy and the macronutrients, protein, carbohydrate, and fat.
Smoking was associated with increased serum testosterone concentrations and after adjustment for other factors, including body mass index. Of the few studies that have previously examined smoking and androgen levels in women, the findings are highly inconsistent.
Longcope and Johnston 14 measured the metabolic clearance rates and production rates of estrogen and androgens in smokers and nonsmokers as part of an ongoing study of hormones and osteoporosis in 88 pre- and postmenopausal women. They found that the metabolic clearance rates for smokers were lower for androstenedione, testosterone, estrone, and estradiol when compared with those of nonsmokers. However, following adjustment for weight, these differences disappeared with the exception of androstenedione.
Khaw et al. Current cigarette use was positively associated with concentrations of the adrenal androgens, dehydroepiandrosterone sulfate, and androstenedione. However, mean concentrations of estrone, estradiol, sex hormone binding globulin, and testosterone did not differ significantly between smokers and nonsmokers.
Thomas et al. They found no significant differences in plasma testosterone, androstenedione, and dehydroepiandrosterone concentrations. A possible explanation for the inconsistency between our findings and those of other studies is the choice of populations to study. The Michigan Bone Health Study subjects are largely premenopausal while the other studies focused primarily on postmenopausal women or a combination of pre- and postmenopausal participants.
In premenopausal women, testosterone is produced in the ovaries and adrenals, while in postmenopausal women, testosterone is produced by the adrenals and the peripheral conversion of androstenedione in adipose tissue. We speculate that the greater concentrations of testosterone observed among current smokers were more likely a product of decreased metabolism rather than increased biosynthesis of the hormone.
Longcope and Johnston 14 provide evidence to support this theory. Cytochrome P hydroxylases are responsible for the oxidative metabolism of steroid hormones in general. These enzymes mediate the introduction of an oxygen atom derived from water or molecular oxygen into the steroid nucleus. P hydroxylases are subject to inhibition by carbon monoxide. Smokers have greater circulating carbon monoxide concentrations as a by-product of tobacco smoke. This may inhibit P hydroxylases and explain the increased concentrations of testosterone and its precursors.
Thus, future studies of androgen and smoking in women need to consider products in the androgen pathway as well as the availability of bioactive testosterone, concentrations of sex hormone binding globulin, and receptor binding. Alcohol consumption was not associated with testosterone concentrations in this study, and findings are inconsistent in other studies. For example, Cigolini et al. One likely explanation for the contrast in findings may be related to the amount and frequency of alcohol consumption.
Testosterone concentrations did not change with the level of physical activity in our study participants, but most studies that have examined the relation between testosterone and physical activity in women have focused on female athletes or on acute changes in testosterone following heavy exercise 19 — Our findings are consistent with those of other studies that have examined exogenous hormone use and androgen levels 22 — Few studies have examined the relation between hysterectomy and testosterone levels, and none have made the distinction between hysterectomy with and without bilateral oophorectomy.
There are two general metabolic pathways by which testosterone is produced, one via the ovary and the other via the adrenals. Pregnenolone appears to be a more efficient precursor of testosterone than progesterone in ovaries without corpus luteum. Women with oophorectomy have decreased levels of testosterone because production relies primarily on the adrenal cortex and peripheral conversion of androstenedione 3.
In our study, hysterectomy with ovarian conservation was associated with significantly higher testosterone concentrations when compared with those of other participants. Of the studies that have focused on the anthropometric predictors of androgen concentrations in women, one found a positive relation 27 and two found no relation after adjustment for other factors 17 , Increases in lean body mass were also reported to be associated with higher testosterone levels in a previous paper from this study It has long been appreciated that a subset of women with significantly higher androgen concentrations was more likely to be obese.
Androgen metabolism is accelerated in obese individuals and is associated with lower sex hormone binding globulin levels, but it is not known whether increased clearance precedes or follows accelerated production of androgen We evaluated whether the observed association of body composition measures and testosterone concentrations was being unduly influenced by a small group of women with hyperandrogenism and its accompanying obesity.
We reconstructed the data set to remove the contribution of those women whose total testosterone level was in the top 5 percent of the androgen distribution. Even in their absence, we still observed significant associations with body composition and smoking behavior. Likewise, because polycystic ovary syndrome is associated with obesity, we reconstructed the data set to remove the contribution of those women in the top 5 percent of the body mass index distribution.
The same variables remained statistically important. This suggests that the findings of smoking, body composition, and reproductive status are not the reflection of undue influence by a subgroup of women in the population with subclinical or undiagnosed polycystic ovary syndrome. This is one of the first papers to describe the correlates of testosterone concentrations in women and the only one that focuses largely on pre- and perimenopausal women.
However, the measures are of total testosterone rather than free, bioavailable testosterone. In addition, there are other limitations in our study design. Although our sample size was large enough to detect significant differences in mean testosterone in most situations, we were unable to contrast differences between postmenopausal women and the other groups because of the small number of postmenopausal participants.
In addition, a 3-year follow-up of these individuals is insufficient to assess changes in testosterone over time and with age. In summary, past research efforts have focused primarily on the relation between estrogen and disease in women and have largely ignored testosterone in relation to health and disease states in women with the exception of a few disorders.
The greater circulating levels of testosterone with obese women and smokers suggest that testosterone may be an important contribution to those disease conditions where obesity and smoking are risk factors, including cardiovascular disease. Correspondence to Dr. Stanley Korneman for their respective contributions.
Manipulation of human ovarian function: physiological concepts and clinical consequences. Endocr Rev ; 18 : 71 — Clinical gynecologic endocrinology and infertility. Baltimore, MD: Williams and Wilkins, — Norman AW, Litwack G.
Relation of serum levels of testosterone and dehydro-epiandrosterone sulfate to risk of breast cancer in postmenopausal women. Am J Epidemiol ; : —8. Diabetes Care ; 17 : — People using this treatment over the long term could experience potentially severe side effects , such as an increased risk of heart problems.
Females who develop PCOS could treat their symptoms by maintaining a moderate weight. A doctor could also recommend hormonal contraception and fertility treatment. Testosterone is a sex hormone. If levels are low, a male may experience erectile dysfunction, a reduction in testicle size, and difficulty sleeping…. Hemoglobin is a protein in red blood cells. Oxygen entering the lungs adheres to this protein, allowing blood cells to transport oxygen throughout the….
People tend to associate testosterone with males, but everyone requires some of this sex hormone. Testosterone levels change over time, and lower…. Testosterone is the male sex hormone, and its levels in the body decline steadily with age. Many people wish to supplement it when they are deficient…. Testosterone is a male sex hormone. Low levels can cause changes to the distribution of body fat and muscle strength.
Testosterone reduces with age…. Typical testosterone levels in males and females. Because the symptoms of such a deficiency resemble those of depression, misdiagnosis and lack of treatment are common. Improved awareness of the symptoms, diagnostic procedures, and appropriate available treatments are needed, to avoid misdiagnosis and unnecessary or inappropriate treatments.
Symptoms of androgen deficiency The symptoms of androgen deficiency in women may very closely resemble other conditions. The chief complaint of androgen-deficient women is decreased sexual desire, which is often characterized by a decrease in sexual thoughts and fantasies, as well as actions. Muscle weakness is another frequent complaint, especially in athletic patients.
It appears that genital arousal and orgasmic response may also be negatively affected, and vaginal lubrication may decrease, even in women who are menstruating regularly. There is some evidence that testosterone, apart from estrogen, may have a direct function in genital arousal and orgasmic physiology. Female androgen metabolism In women, testosterone is produced in various locations.
One quarter of the hormone is produced in the ovary, a quarter is produced in the adrenal gland, and one half is produced in the peripheral tissues from the various precursors produced in the ovaries and adrenal gland.
There is also much interconversion among steroid hormones. The main precursor in the ovary is androstenedione, which is converted primarily to estrone, but which can also be converted to androgens. It is, therefore, reasonable to expect the symptoms of testosterone deficiency after menopause, since nearly half of the testosterone is manufactured by the ovary, although the post-menopausal ovary still produces some steroid hormones.
The recent finding of decreased testosterone and DHEA-S production in both pre- and post-menopausal women brings up the possibility of an enzyme defect causing decreased DHEA production. DHEA is derived from 17 hydroxypregnenolone through the action of the enzyme 17, 20 lyase. If this enzyme is deficient, the DHEA would be low. However, because little attention has been paid publicly to female sexual dysfunction, this area has remain neglected, and only now is there understanding of such disorders in women.
This would put the number of women with decreased libido in the tens of millions in this country alone. How many of these women have decreased androgens is unknown, but the number is estimated to be between 10 and 15 million. Who may be affected? Most of the current clinical experience with androgens and androgen deficiency has been in post-menopausal women who complain of decreased sexual desire after cessation of menses, and are not helped by estrogen replacement therapy alone.
The question of androgen deficiency has largely been ignored in pre-menopausal women. Testosterone levels have usually been measured in this population only when looking for excess production in women complaining of facial hair, loss of scalp hair, infertility, or acne.
J Clin Endocrinol Metab. Endocrinol Metab Clin North Am. Dumesic DA: Hyperandrogenic anovulation: a new view of polycystic ovary syndrome. Postgrad Obstet Gynecol. J Lab Clin Med. Endocr Rev. Skip to main content. Register Sign In. Test Catalog Account. Outreach Solutions Tactics Articles Events. Utilization Management Algorithms. Test Catalog. Download Test. Useful For Suggests clinical disorders or settings where the test may be helpful Second- or third-order test for evaluating testosterone status eg, when abnormalities of sex hormone-binding globulin are present.
Total testosterone and general interpretation of testosterone abnormalities: In male patients: Decreased testosterone levels indicate partial or complete hypogonadism. Monitoring of testosterone replacement therapy: Aim of treatment is normalization of serum testosterone and LH. In female patients: Decreased testosterone levels may be observed in primary or secondary ovarian failure, analogous to the situation in men, alongside the more prominent changes in female hormone levels.
Increased testosterone levels may be seen in: -Congenital adrenal hyperplasia: non-classical mild variants may not present in childhood but during or after puberty. Monitoring of testosterone replacement therapy: The efficacy of testosterone replacement in females is under study. Monitoring of antiandrogen therapy: Antiandrogen therapy is most commonly employed in the management of mild-to-moderate "idiopathic" female hyperandrogenism, as seen in polycystic ovarian syndrome.
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