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DHEA in women with hypoandrogenism—debate remains open

Nature Reviews Endocrinology volume 11, page 521 (2015)Cite this article

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We read with great interest an article published in the July 2015 issue of Nature Reviews Endocrinology (Genetics of androgen metabolism in women with infertility and hypoandrogenism. Nat. Rev. Endocrinol. 11, 429–441; 2015),1 by Aya Shohat-Tal and colleagues. This well-written Review answers, among others, the question of how hormonal profiles of women with hypoandrogenism reflect their ability to metabolize DHEA to testosterone following supplementation with the androgen dehydroepiandrosterone (DHEA). In principle, we agree with their Review; however, we would like to note some points that need to be addressed further.

Shohat-Tal and colleagues state that the benefits of DHEA supplementation might only become clinically apparent in women with testosterone levels below certain (abnormally low) thresholds. However, even though hypoandrogenism is defined as low levels of androgens, what actually constitutes really low levels of testosterone, DHEA and dehydroepiandrosterone sulphate (DHEAS) in each individual patient is not known. We agree that although some women (<50 years of age) have levels of testosterone and DHEAS below 8.68 nmol/l and 40.74 nmol/l, respectively, these women cannot have hypoandrogenism.2 Furthermore, some women with normal ranges of these hormones develop symptoms of hypoandrogenism and can have low functional ovarian reserve (LFOR), especially those women with borderline results. Distinguishing between low-normal and high-normal ranges of these hormones (such as for low-normal and high-normal levels of thyroid-stimulating hormone) might be needed.

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References

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Authors and Affiliations

  1. INVICTA Fertility and Reproductive Center, ul. Trzy Lipy 3, 80–172 Gdansk, Poland

    Michał Kunicki & Joanna Liss

  2. Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, ul. Debinki 7, 80–211 Gdansk, Poland

    Krzysztof Łukaszuk

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  1. Michał Kunicki
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  2. Krzysztof Łukaszuk
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Correspondence to Michał Kunicki.

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Kunicki, M., Łukaszuk, K. & Liss, J. DHEA in women with hypoandrogenism—debate remains open. Nat Rev Endocrinol 11, 521 (2015). https://doi.org/10.1038/nrendo.2015.107

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