How does testosterone convert to estrogen
Testosterone in women
Although testosterone is the most important representative of the male sex hormones, the androgens, it is produced in both men and women.1
What functions does testosterone have in women?
In women, some of the testosterone is produced by converting androstenedione and dehydroepiandrosterone in peripheral tissues. It is also produced in the ovaries.2
First and foremost, testosterone is important for estradiol synthesis in women. Testosterone is converted into estradiol by an aromatase. A high level of aromatase activity can be demonstrated primarily in the ovaries, but also in breast tissue, the liver and in subcutaneous adipose tissue.1
However, some research suggests that testosterone itself also has an important function in the female body. Androgen receptors can be detected in a large number of organs. These include Breast, brain, bones, muscles, adipose tissue, liver and skin.3
Testosterone stimulates the development of muscles in a gender-unspecific manner, namely by stimulating pluripotent stem cells to form satellite cells and myoblasts.4 In addition, testosterone promotes the formation of erythrocytes and their iron absorption as well as bone formation.5,6 A libido-increasing effect of testosterone has been demonstrated in ovariectomized women.2
In contrast to estradiol, testosterone may have an antiproliferative effect by binding to the androgen receptor by reducing the estrogen receptor activity. Testosterone in the form of subcutaneous implants may reduce the risk of breast cancer.7
After menopause, there is a decrease in testosterone and estrogen production by the ovaries. This is linked to a wide variety of symptoms that can be caused by the interaction of both hormones. In women, the decrease in estrogens in particular is associated with reduced bone density and thus an increased risk of osteoporosis.6
Treating women with testosterone
There is no fundamental medical-scientific consensus with regard to the diagnosis and treatment of female androgen deficiency, however a testosterone treatment attempt is recommended in ovariectomized or postmenopausal women with pathologically reduced sexual interest.8
In particular, the application of testosterone through the skin has shown positive effects on sexual function and libido in women with androgen deficiency after hysterectomy and oophorectomy or after natural menopause, with the women already responding to conventional hormone replacement therapy with estrogen and - in women with uterus - progestin were permanently set.9 For treatment, it is considered important that testosterone concentrations remain in the normal range for women of around 0.6 ng / ml (corresponding to 2 nmol / l) and are not permanently increased to supraphysiological values. There are currently no testosterone drugs approved for the treatment of women.
In this context, it should be noted that pregnancy must be ruled out, as testosterone can have harmful virilizing effects on the fetus.
Aktories, K., Förstermann, U., Hofmann, F.B., Starke, K. (2005). General and special pharmacology and toxicology. Elsevier GmbH, Urban & Fischer Verlag, 9th edition.
Reed, B. G., Bou Nemer, L., Carr, B. R. (2016, Oct). Has testosterone passed the test in premenopausal women with low libido? A systematic review. Int J Womens Health, (8), pp. 599-607.
Elraiyah, T., et al. (2014, Oct). The benefits and harms of systemic testosterone therapy in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab, 99 (10), pp. 3543-3550.
Jones, T. (2009). Advances in the Management of Testosterone Deficiency. S. Karger AG.
Nieschlag, E., Behre, H. M., Nieschlag, S. (2010). Andrology. Springer Verlag, 3rd edition.
Hugh Jones, T. (2008). Testosterone Deficiency in Men. Oxford University Press.
Glaser, R., Dimitrakakis, C. (2015, Nov). Testosterone and breast cancer prevention. Maturitas, 82 (3), pp. 291-5.
Wierman, M.E., Arlt, W., Basson, R., et al. (2014). Androgen therapy in women: A reappraisal: An Endocrine Society Clinical Practice guideline. J Clin Endocrinol Metab, 99, pp. 3489-51.
Davis, S.R., Wahlin-Jacobsen S (2015). Testosterone in women - the clinical significance. Lancet Diabetes Endocrinol, 3, pp. 980-92.
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