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Androgens In The Regulation of Insulin Sensitivity in Postmenopausal Women

Finding may have implications for testosterone replacement in this population.Glucose and insulin components of the metabolic syndrome appear to be linked with hyperandrogenism in postmenopausal women. Dr. Sherita Hill Golden of the Johns Hopkins University School of Medicine, with colleagues there and elsewhere, conducted a cross-sectional analysis of a subset of participants in the Atherosclerosis Risk in Communities Study.

The authors analyzed data on 181 women with significant carotid atherosclerosis and 181 case-control subjects with minimal carotid atherosclerosis. These subjects had been previously selected for an analysis of the association between endogenous postmenopausal hormones and atherosclerosis in women who had never used hormone replacement therapy.

The investigators estimated the free androgen index based on the ratio of total testosterone to sex hormone-binding globulin.
"Free androgen index, but not total testosterone, was strongly associated with the metabolic syndrome," the authors report in the September 15th issue of the American Journal of Epidemiology. They add that women in the highest free androgen index quartile had five times the risk of having the metabolic syndrome as did women in the lowest quartile.

On multivariate analysis, according to the article, "Higher free androgen index was associated with the hyperinsulinemia and hyperglycemia components of the metabolic syndrome." This finding held true "even among women without diabetes."
"Our study suggests a role of androgens in the regulation of insulin sensitivity in postmenopausal women," the authors conclude. They caution: "When testosterone replacement for postmenopausal women is considered, the effects of androgen administration on insulin sensitivity and glucose metabolism should be explored further." Am J Epidemiol 2004;160:540-548.
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