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Submitted on October 18, 2004
Accepted on April 12, 2005
From the Department of Ob/Gyn & Women's Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY and SWAN Clinical Centers: University of Michigan, Ann Arbor, MI (U01 NR04061, Mary Fran Sowers, PI): Massachusetts General Hospital, Boston, MA (U01 AG12531, Robert Neer, PI 1994-1999; Joel Finkelstein, PI); Rush University, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL (U01 AG12505, Lynda Powell, PI); University of California, Davis/Kaiser (U01 AG12554, Ellen Gold, PI); University of California, Los Angeles (U01 AG12539, Gail Greendale, PI);University of Medicine and Dentistry/New Jersey Medical School, Newark, NJ (U01 AG12535, Gerson Weiss, PI 1994-2004; Nanette Santoro, PI); and the University of Pittsburgh, Pittsburgh, PA (U01 AG12546, Karen Matthews, PI); Laboratory: University of Michigan, Ann Arbor, MI (U01 AG12495, Central Ligand Assay Satellite Services, Daniel McConnell, PI) and Medical Research Laboratories (MRL), Highland Heights, KY (subcontract of U01 AG12553, Evan Stein, Director) Coordinating Center: New England Research Institutes, Watertown, MA (U01 AG12553, Sonja McKinlay, PI) and University of Pittsburgh, Pittsburgh, PA (U01 AG12553, Kim Sutton-Tyrrell, PI). Also supported by K24 DK02759 (JSF), K24 HD419782 (NS), K12 HD 01457 (JT). Project Officers: Yvonne Bryan, Taylor Harden, Carole Hudgings, Marcia Ory, Sheryl Sherman; Steering Committee Chair: Susan Johnson, MD
* To whom correspondence should be addressed. E-mail: glicktoro{at}aol.com.
Context: Androgens influence sexual differentiation and behavior, body composition, and physical functioning in men, but their role in women is less well understood. Because circulating androgens decline with age, the use of androgen supplementation for women to improve health and well being has been increasing.
Objective: To assess the association between androgens and a variety of end points thought to be affected by androgens.
Design: Community based baseline cohort of women aged 42-52 from the Study of Women's Health Across the Nation (SWAN). We measured circulating testosterone (T), dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG), and calculated a free androgen index (FAI) in 2961 women.
Main Outcome Measures: Correlations of androgen measures with each other and with body mass index (BMI), waist circumference, and waist-hip ratio (WHR) were computed, and odds ratios were estimated for the categorical outcomes of functional limitations, functional status, self-reported health, scores indicative of depressed mood, quality of life, sexual desire and arousal, and the presence of the metabolic syndrome.
Results: Androgens, and particularly SHBG, were most strongly associated with BMI, waist circumference and WHR. SHBG was prominently inversely associated with the metabolic syndrome (OR= 0.32, 95% CI=0.26-0.39), which was present in 17% of women at baseline. DHEAS was modestly associated with functional status and self-reported health. T was minimally associated with increased sexual desire (OR=1.09, 95% CI =1.00-1.18). The association of FAI with self-reported health and depressive symptomatology based on the Center for Epidemiologic Studies--Depression Scale (CES-D) score was explained more by T than by SHBG, while the association of FAI with sexual arousal and metabolic syndrome was due more to SHBG than to T.
Conclusions: Circulating SHBG and androgens are most strongly associated with physical characteristics and the metabolic syndrome in women in this community-based cohort. Androgens are weakly related to physical functioning and other symptoms to which they are commonly attributed, such as sexual desire, sexual arousal and well being.
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