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The Age-Associated Decline of Androgens in Reproductive Age and Menopausal Black and White Women

Department of Obstetrics and Gynecology (A.K., R.A.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Department of Obstetrics and Gynecology (A.K., R.A.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California 90095; Department of Gynecology and Obstetrics (J.B.S.), Emory University, Atlanta, Georgia 30308; and School of Public Health (M.K.), Emory University, Atlanta, Georgia 30322

Address all correspondence and requests for reprints to: Ricardo Azziz, M.D., M.P.H., M.B.A., Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West Third Street, Suite 160W, Los Angeles, California 90048. E-mail: azzizr{at}cshs.org.

Context: The effect of race and obesity on the age-associated decline of androgens in reproductive-aged and menopausal women has not been well characterized.

Objective: Our objective was to determine the impact of racial differences and body mass index (BMI) on the change in androgen levels during a woman’s reproductive and early menopausal years.

Design and Setting: We conducted a frequency-matched cross-sectional study at a tertiary academic medical center.

Patients or Other Participants: Subjects included 260 healthy, nonhirsute and eumenorrheic, self-identified Black and White women, ages 15–60 yr.

Interventions: A medical and reproductive history, physical exam, and blood sampling were determined in the fasting state during the early follicular phase.

Main Outcome Measures: Serum levels of androgens or androgen metabolites (dehydroepiandrosterone sulfate, androstenedione, and total and free testosterone) and SHBG were measured and the BMI, the waist-to-hip ratio (WHR), and the basal insulin resistance estimated by the homeostasis model assessment for insulin resistance determined.

Results: After controlling for differences in BMI, insulin resistance, and WHR, Black women had lower androgen levels than age-matched White women. All androgens, or androgen metabolites, declined similarly across the reproductive lifespan and menopausal transition in both Black and White women. Race was a significant predictor of dehydroepiandrosterone sulfate, androstenedione, and total and free testosterone but not SHBG.

Conclusions: Eumenorrheic, nonhirsute Black women have a lower range of normal androgen levels than White women of the same age, BMI, WHR, and homeostasis model assessment index for insulin resistance. Race and age-adjusted data should be considered when evaluating androgen levels in women between the ages of 15 and 60 yr.

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