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Hyperandrogenism & Metabolic Syndrome in Women

What it is: Hyperandrogenism?

According to the Metabolic Syndrome Institute, metabolic syndrome affects up to 25% of the world population including more than 40% of the United States population and 30% of Europeans. Incidence increases with age and many lifestyle factors, including sedentary lifestyle and poor dietary habits.

Healthcare costs for individuals with metabolic syndrome are at least 37% higher than for those without, and this figure increases based on the combination of risk factors an affected individual has. In addition to costing more financially, metabolic syndrome can also be costly to an individual's future health if not recognized, addressed and reversed early on.

An individual with metabolic syndrome is twice as likely to develop diabetes and 5 times as likely to develop cardiovascular disease (heart disease, hypertension, heart attack and stroke) than an individual without metabolic syndrome. A diagnosis of metabolic syndrome is given when a patient displays 3 or more of the following signs and symptoms:

Elevated Fasting Glucose (100 -125 mg/dl)

2 hr glucose (on GTT) between 140 and 199

Elevated fasting insulin (>20 mcl)

2 hr insulin (on IGTT) >27

Fasting Triglycerides:

150 mg/dl or higher
or taking medicine for elevated triglycerides

Fasting HDL:

less than 50 mg/dl in women
less than 40 mg/dl in men
or taking medication for low HDL levels
Increased Blood Pressure:
Systolic: 130 or greater
Diastolic: 85 or greater
or taking medication for elevated blood pressure

Waist measurement:

35" or greater for women
40" or greater for men

The recognition of metabolic syndrome lowers your morbidity by specifically decreasing your risk of developing cardiovascular disease and diabetes.

Utilizing lab screening for fasting glucose, insulin and cholesterol levels will help  identify affected individuals.

In addition, salivary hormone testing may help you identify at risk for developing insulin resistance early on in its progression because of the relationship between insulin and androgen hormones.

Hyperandrogenism (increased testosterone and/or DHEA levels) in women is indicative of developing insulin resistance.

Androgen production sites include the ovaries, the adrenal glands and the peripheral tissues. The major androgen produced in the ovaries is testosterone although the ovaries also produce androstenedione and DHEA.

The adrenal glands produce DHEA-S in largest amounts, but also produce androstenedione and DHEA. In the periphery, there is conversion of androstenedione to testosterone and DHEA, as well as conversion of DHEA to testosterone. Because the adrenal glands and ovaries produce approximately equal amounts of androstenedione and DHEA, 2/3 of the total daily testosterone production in women comes from the ovaries.


Origin of Testosterone in Women
 
Origin    Amount (mg/day)       
Ovarian secretion    0.1       
Peripheral Conversion           
Androstenedione to testosterone    0.2       
Dehydroepiandrosterone to testosterone    0.05       
Total testosterone production    0.35  

 
The ovaries are sensitive to insulin and insulin-like growth factor - 1 (IGF-1). Individuals with insulin resistance have increased levels of insulin and may or may not have increased fasting blood glucose, depending on where they are in the progression of the condition.

Increased levels of insulin and IGF-1 potentiate the stimulatory effects of luteinizing hormone (LH) on the ovarian theca cells, increasing the production of ovarian androstenedione and testosterone resulting in increased levels of DHEA and/or testosterone  as seen on the salivary hormone panels of affected female patients. Utilizing salivary hormone testing to identify women with hyperandrogenism will help you identify current or future risk for developing insulin resistance and metabolic syndrome.

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References:

Boudreau DM et al.; "Health care utilization and costs by metabolic syndrome risk factors.";Metab Syndr Relat Disord.; 2009 Aug;7(4):305-14.

Katz: Comprehensive Gynecology, 5th ed., 2007

American Heart Association; "About Metabolic Syndrome;" AmericanHeart.org

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The Canary Club is an educational advisory group with a team of medical advisors headed by Richard Shames, M.D.