Abstract

Hyperandrogenicity in women is not only seen in relatively rare conditions such as polycystic ovary syndrome (PCOS) and nonclassical congenital adrenal hyperplasia, but also in the population of women selected at random. Hyperandrogenism is tightly associated with insulin resistance and visceral obesity, and, clearly, women with visceral obesity are hyperandrogenic with and without accompanying non-insulin-dependent diabetes mellitus (NIDDM). This male pattern of adipose tissue distribution and the increasing levels of free testosterone work in concert to further exaggerate the risk for development of NIDDM and cardiovascular disease (CVD). Reducing hyperandrogenicity with antiandrogen agents has usually not ameliorated insulin resistance, although the data are conflicting. Estrogen replacement therapy (ERT) reduces the levels of free testosterone, which may be followed by improvement of glucose homeostasis, insulin sensitivity and lipoproteins, both in nondiabetic and diabetic women. These beneficial changes in metabolic risk factors may be a plausible background mechanism to explain the reduction of coronary artery disease seen with sustained estrogen use. However, many women with hyperandrogenism and visceral obesity are currently untreated. Therefore it must be strongly recommended that intervention in these women with a change in lifestyle factors, such as weight reduction and exercise, alone or in combination with pharmacological agents, is warranted.

DOI: Clin. Lab. 1999;45:165-176