Clinical Practice Guideline Update: Androgens in Women
The Endocrine Society has updated its Clinical Practice Guideline (CPG), advising against the use of testosterone therapy in women.
The CPG, published recently in the Journal of Clinical Endocrinology and Metabolism, is an update to the Society’s 2006 recommendations, since new research has addressed concerns over testosterone and dehydroepiandrosterone (DHEA) therapies being used in women. There have also been advances in testosterone testing and measurement techniques in the past eight years.
“Although limited research suggests testosterone therapy in menopausal women may be linked to improved sexual function, there are too many unanswered questions to justify prescribing testosterone therapy to otherwise healthy women,” says Margaret E. Wierman, MD, of the University of Colorado in Aurora, and the Society’s vice president of Clinical Science and chair of the task force that authored the guideline. “When we reviewed past studies, we found many women who had low testosterone levels measured by older or new techniques did not exhibit any signs or symptoms of concern. As a result, physicians cannot make a diagnosis of androgen deficiency in women.”
The updated CPG includes:
• Recommendations against making a diagnosis of androgen deficiency syndrome in healthy women because there is a lack of a well-defined syndrome and data correlating androgen levels with specific signs or symptoms are unavailable.
• Recommendations against the general use of T for the following indications: infertility; sexual dysfunction other than hypoactive sexual desire disorder; cognitive, cardiovascular, metabolic, or bone health; or general well-being.
• Recommendations against the routine use of dehydroepiandrosterone due to limited data concerning its effectiveness and safety in normal women or those with adrenal insufficiency.
• Recommendations against the routine prescription of T or dehydroepiandrosterone for the treatment of women with low androgen levels due to hypopituitarism, adrenal insufficiency, surgical menopause, pharmacological glucocorticoid administration, or other conditions associated with low androgen levels because there are limited data supporting improvement in signs and symptoms with therapy and no long-term studies of risk.
• Outlines for future research, since ongoing improvement in androgen assays will allow a redefinition of normal ranges across the lifespan. This may help to clarify the impact of varying concentrations of plasma androgens on the biology, physiology, and psychology in women and lead to indications for therapeutic interventions.
“Currently, there isn’t enough evidence that any benefits outweigh the risks to most women,” Wierman says. “More research is needed to determine the long-term safety of testosterone therapy in postmenopausal women.”
Remembering William H. Daughaday, MD, (1918 – 2013)
On May 3, 2013, former Endocrine Society president William H. Daughaday passed away at age 95. Sam Dagogo-Jack, MD, A.C. Mullins Professor in Translational Research, director, Division of Endocrinology, Diabetes & Metabolism, director, General Clinical Research Center, The University of Tennessee Health Science Center, Memphis, Tenn., calls Daughaday a “towering fi gure in endocrinology… and a pioneer neuroendocrinologist whose work led to the discovery of the somatomedins (Insulin-like Growth Factors) that mediate the skeletal growth effects of Growth Hormone…and opened up the fi eld of binding proteins (cortisol binding protein, IGF binding proteins) in endocrine physiology.”
Daughaday was one of Dagogo-Jack’s attending physicians and professors when he began his endocrinology fellowship training at Washington University in St. Louis, Mo., in 1990. “He quickly became a trusted mentor and was instrumental in my decision to commit to a career in academic endocrinology,” he says. “I sought his advice often and benefi tted greatly from his deep understanding of life and academia. As a fellow and later junior faculty, Dr. Daughaday painstakingly read my draft manuscripts and research grants, and used his vast experience and insight to make extremely valuable suggestions for improvement.”
Dagogo-Jack credits that degree of informal but hands-on, time-consuming “uber mentorship” with providing him quintessential training during his early development as an endocrinology faculty member at Washington University. “I am immensely grateful to have been influenced by such a gifted scientist and mentor,” he says. Dagogo-Jack reached out to Endocrine News to share his poetic tribute to his late mentor, who had such a remarkable influence on his life.
Voice of the Oak
Nary an empty seat, nary a sound
Save the soft monotone that holds spell-bound,
Shorn of crescendo and low in timbre,
Yet luring no reverie or slumber.
Ears and eyes ajar, pupils dilating
From dim light and surging adrenaline;
Not fight or flee, acrophobia perhaps:
The looming climb on the tree of science.
Clinical wisdom, endocrine vignettes,
Delivered in still vocal packages;
Wrapped within intertwined clues and secrets,
Decoding rife and mysterious ailments.
Shy doyen of the scientific realm;
Friend to adepts and novices the same;
Sacrificing neither bench nor bedside,
The pearls from the quiet sage resound.
Unmasker of mediators of man’s growth
And of the proteins that carry them forth,
Whence Nature’s laws of stature are laid bare,
As the long and short are served with éclat.
Such simplicity, clarity, humor;
Such perspicacity, insight, candor
Forever inform and enrich each day
In remembrance of the voice of Daughaday.
— Daughaday’s obituary can be found at: http://news.wustl.edu/news/Pages/25414.aspx.
Explore What’s New at
ENDO never stops evolving. And this year is no different: The new additions at ENDO 2015 provide the innovation and information today’s endocrinologists need to keep pushing the field forward — in engaging and entertaining formats.
Get Your Images Ready
ENDO’s first-ever imaging competition, EndoScapes, moves your work from under the microscope into the spotlight. To participate in EndoScapes, simply submit your best original image along with a 100-word description of the science represented. Registered ENDO 2015 scientific attendees will vote for their favorite images during ENDOExpo hours.
The winning image will appear in the May 2015 issue of Endocrine News, along with information about the author and related research. Other winners will appear in the Endocrine Society’s official 2016 calendar.
For more details and official rules, visit endocrine. org/endoscapes.
ESAP™ Live Sessions:
Prepare with Hands-on Help
The Endocrine Self-Assessment Program (ESAP) is crucial for keeping up to date in your practice and a key tool to earning ABIM-MOC points. New to ENDO 2015, take advantage of ESAP Live sessions. Offered each day, these sessions will cover ESAP 2015 clinical cases in the full spectrum of endocrine topics. Explore the cases and discuss their complexities directly with the authors before continuing your learning with the full ESAP 2015 activity.
Pre-order your copy of ESAP 2015 with your ENDO 2015 registration and gain access to this track of sessions.
Learn Strategies for Career Success:
Meet the Editors-in-Chief and
Meet the Program Director Sessions
What’s the best way to get published? How can you secure funding from the foremost research institutes? ENDO 2015 connects you to the experts. Editors-inchief of three of the field’s leading journals will provide guidance for publishing in an increasingly competitive landscape, cover common author pitfalls, and outline their visions for the future of publishing.
You can also learn the best strategies for applying for support during Meet the Program Director sessions, featuring representatives from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Environmental Health Sciences, and the National Institute on Minority Health and Health Disparities.
Don’t miss the most innovative ENDO yet. Register now at endo2015.org.