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{{Infobox medical condition (new)
| name = Androgen deficiency
| synonyms = Hypoandrogenism, androgen deficiency syndrome, men with hypogonadism,<ref name=Bha2018/> testosterone deficiency
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'''Androgen deficiency''' is a [[medical condition]] characterized by insufficient [[androgen]]ic activity in the body. Androgen deficiency most commonly affects women, and is also called '''Female androgen insufficiency syndrome''' (FAIS), although it can happen in both sexes.<ref name=oct2004>{{Cite journal|title=Androgen insufficiency in women: diagnostic and therapeutic implications|first1=L. M.|last1=Rivera-Woll|first2=M.|last2=Papalia|first3=S. R.|last3=Davis|first4=H. G.|last4=Burger|date=October 1, 2004|journal=Human Reproduction Update|volume=10|issue=5|pages=421–432|doi=10.1093/humupd/dmh037|pmid=15297435|doi-access=free}}</ref><ref name="auto">{{Cite journal|title=Androgen insufficiency in women: summary of critical issues|first=Glenn D|last=Braunstein|date=April 1, 2002|journal=Fertility and Sterility|volume=77|pages=94–99|doi=10.1016/S0015-0282(02)02962-X|pmid=12007911|doi-access=free}}</ref> Androgenic activity is mediated by androgens (a class of [[steroid hormones]] with varying affinities for the [[androgen receptor]]), and is dependent on various factors including androgen receptor abundance, sensitivity and function. Androgen deficiency is associated with lack of energy and motivation, depression, lack of desire ([[libido]]), and in more severe cases changes in [[secondary sex characteristic]]s.<ref name="auto"/><ref>{{Cite journal|title=Androgen insufficiency in women|first=Glenn D.|last=Braunstein|date=July 1, 2006|journal=Growth Hormone & IGF Research|volume=16|pages=109–117|doi=10.1016/j.ghir.2006.03.009|pmid=16631401}}</ref><ref>{{cite journal |last1=Tan |first1=RS |title=Testosterone replacement therapy for female androgen insufficiency syndrome |journal=International Journal of Pharmaceutical Compounding |date=July 2005 |volume=9 |issue=4 |pages=259–64 |pmid=23925049 |url=https://ijpc.com/Abstracts/FindByVolPage.cfm?Vol=9&Page=259 }}</ref><ref>{{Cite journal|title=Androgens in women|first1=Sonia L|last1=Davison|first2=Susan R|last2=Davis|date=June 1, 2003|journal=The Journal of Steroid Biochemistry and Molecular Biology|volume=85|issue=2|pages=363–366|doi=10.1016/S0960-0760(03)00204-8|pmid=12943723|s2cid=8048483}}</ref><ref>{{cite journal |last1=Guay |first1=A |last2=Traish |first2=A |title=Testosterone therapy in women with androgen deficiency: Its time has come |journal=Current Opinion in Investigational Drugs |date=October 2010 |volume=11 |issue=10 |pages=1116–26 |pmid=20872314 |s2cid=24910370 }}</ref><ref>{{Cite journal|title=Serum androgen levels in healthy premenopausal women with and without sexual dysfunction: Part A. Serum androgen levels in women aged 20–49 years with no complaints of sexual dysfunction|first1=A.|last1=Guay|first2=R.|last2=Munarriz|first3=J.|last3=Jacobson|first4=L.|last4=Talakoub|first5=A.|last5=Traish|first6=F.|last6=Quirk|first7=I.|last7=Goldstein|first8=R.|last8=Spark|date=April 24, 2004|journal=International Journal of Impotence Research|volume=16|issue=2|pages=112–120|doi=10.1038/sj.ijir.3901178|pmid=14999217|s2cid=22139942 |doi-access=}}</ref><ref>{{Cite journal |date=2021-05-17 |title=Corrigendum to: "Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline" |url=http://dx.doi.org/10.1210/clinem/dgab306 |journal=The Journal of Clinical Endocrinology & Metabolism |volume=106 |issue=7 |pages=e2843 |doi=10.1210/clinem/dgab306 |issn=0021-972X}}</ref>
 
<!-- Definition and symptoms -->
'''Androgen deficiency''' is a [[medical condition]] characterized by not enough [[androgen]]ic activity in the body.
 
==Signs and symptoms==
Symptoms of the condition in males consist of loss of [[libido]], [[impotence]], [[infertility]], shrinkage of the [[testicle]]s, [[penis]], and [[prostate]], diminished [[virilization|masculinization]] (e.g., decreased [[facial hair|facial]] and [[body hair]] growth), low [[muscle]] mass, [[anxiety]], [[depression (mood)|depression]], [[fatigue (medical)|fatigue]], [[vasomotor symptom]]s ([[hot flash]]es), [[insomnia]], [[headache]]s, [[cardiomyopathy]] and [[osteoporosis]]. In addition, symptoms of [[hyperestrogenism]], such as [[gynecomastia]] and [[feminization (biology)|feminization]], may be concurrently present in males.<ref name=":0">{{citationCite neededjournal |last1=Ponholzer |first1=Anton |last2=Madersbacher |first2=Stephan |date=May 2009 |title=Re: Christina Wang, Eberhard Nieschlag, Ronald Swerdloff, et al. Investigation, Treatment, and Monitoring of Late-Onset Hypogonadism in Males: ISA, ISSAM, EAU, EAA, and ASA Recommendations. Eur Urol 2009;55:121–30 |url=http://dx.doi.org/10.1016/j.eururo.2008.11.053 |journal=European Urology |volume=55 |issue=5 |pages=e92; author reply e93-4 |doi=10.1016/j.eururo.2008.11.053 |pmid=19081175 |issn=0302-2838}}</ref>
 
In males, a type of [[myopathy]] can result from androgen deficiency known as '''testosterone deficiency myopathy''' or (hypogonadotropic) hypogonadism with myopathy. Signs and symptoms include elevated serum [[Creatine kinase|CK]], symmetrical [[muscle wasting]] and [[muscle weakness]] (predominantly [[proximal]]), a burning sensation in the feet at night, [[waddling gait]], and impaired fasting glucose. [[Electromyography|EMG]] showed low volitional contraction of short duration polyphasic units. Muscle biopsy showed evidence of [[Necrosis#Other clinical classifications of necrosis|myonecrosis]] and [[Regeneration in humans|regeneration]], some fibre splitting, chronic inflammatory cells ([[macrophage]]s) infiltrating degenerating fibres, and an increase in adipose and fibrous tissue ([[fibrosis]]). A predominance of type I (slow-twitch/oxidative) [[Skeletal muscle#Fiber types|muscle fibres]], with some mixed atrophy of type II (fast-twitch/glycolytic) muscle fibres. Treatment is hormone replacement therapy of testosterone.<ref>Needham, Merrilee, and Frank Mastaglia, 'Endocrine myopathies', in David Hilton-Jones, and Martin R. Turner (eds), ''Oxford Textbook of Neuromuscular Disorders'', Ch. 38 Endocrine myopathies. Oxford Textbooks in Clinical Neurology (Oxford, 2014; online edn, Oxford Academic, 1 May 2014), {{doi|10.1093/med/9780199698073.003.0034}}. Retrieved 29 May 2023.</ref><ref>{{Cite journal |last1=Orrell |first1=R W |last2=Woodrow |first2=D F |last3=Barrett |first3=M C |last4=Press |first4=M |last5=Dick |first5=D J |last6=Rowe |first6=R C |last7=Lane |first7=R J |date=August 1995 |title=Testosterone deficiency myopathy. |journal=Journal of the Royal Society of Medicine |volume=88 |issue=8 |pages=454–456 |issn=0141-0768 |pmc=1295300 |pmid=7562829}}</ref><ref>{{Cite journal |last1=Haq |first1=T. |last2=Pathan |first2=M. F. |last3=Ikhtaire |first3=S. |date=January 2016 |title=Hypogonadotropic Hypogonadism in a Boy with Myopathy |url=https://pubmed.ncbi.nlm.nih.gov/26931274/ |journal=Mymensingh Medical Journal: MMJ |volume=25 |issue=1 |pages=186–189 |issn=1022-4742 |pmid=26931274}}</ref>
In females, hypoandrogenism consist of loss of [[libido]], decreased [[body hair]] growth, [[depression (mood)|depression]], [[fatigue (medical)|fatigue]], [[vasocongestion|vaginal vasocongestion]] (which can result in [[cramp]]s), [[vasomotor symptom]]s (e.g., hot flashes and [[palpitation]]s), insomnia, headaches, [[osteoporosis]] and reduced [[muscle]] mass.<ref name="pmid16821229">{{cite journal | vauthors = Jakiel G, Baran A | title = [Androgen deficiency in women] | language = Polish | journal = Endokrynologia Polska | volume = 56 | issue = 6 | pages = 1016–20 | year = 2005 | pmid = 16821229 | doi = }}</ref><ref name="pmid12007907">{{cite journal | vauthors = Bachmann GA | title = The hypoandrogenic woman: pathophysiologic overview | journal = Fertility and Sterility | volume = 77 Suppl 4 | issue = | pages = S72–6 | date = April 2002 | pmid = 12007907 | doi = 10.1016/S0015-0282(02)03003-0 }}</ref><ref name="Bremner2003">{{cite book | first = William J. | last = Bremner | name-list-format = vanc | title = Androgens in Health and Disease | url = https://books.google.com/books?id=kUDc9cS50fcC&pg=PA365 | accessdate = 11 June 2012 | date = 27 May 2003 | publisher = Humana Press | isbn = 978-1-58829-029-8 | pages = 365–379}}</ref> Symptoms of [[hypoestrogenism]] may be present in both sexes in cases of severe androgen deficiency (as estrogens are synthesized from androgens).▼
 
▲In females, hypoandrogenism consist of loss of [[libido]], decreased [[body hair]] growth, [[depression (mood)|depression]], [[fatigue (medical)|fatigue]], [[vasocongestion|vaginal vasocongestion]] (which can result in [[cramp]]s), [[vasomotor symptom]]s (e.g., hot flashes and [[palpitation]]s), insomnia, headaches, [[osteoporosis]] and reduced [[muscle]] mass.<ref name="pmid16821229">{{cite journal | vauthors = Jakiel G, Baran A | title = [Androgen deficiency in women] | language = Polishpl | journal = Endokrynologia Polska | volume = 56 | issue = 6 | pages = 1016–20 | year = 2005 | pmid = 16821229 | doi = }}</ref><ref name="pmid12007907">{{cite journal | vauthors = Bachmann GA | title = The hypoandrogenic woman: pathophysiologic overview | journal = Fertility and Sterility | volume = 77 Suppl 4 | issuepages = S72–6 | pagesdate = S72–6April 2002 | dateissue = AprilSuppl 20024 | pmid = 12007907 | doi = 10.1016/S0015-0282(02)03003-0 | doi-access = free }}</ref><ref name="Bremner2003">{{cite book | first = William J. | last = Bremner | name-list-formatstyle = vanc | title = Androgens in Health and Disease | url = https://books.google.com/books?id=kUDc9cS50fcC&pg=PA365 | accessdate = 11 June 2012 | date = 27 May 2003 | publisher = Humana Press | isbn = 978-1-58829-029-8 | pages = 365–379}}</ref> SymptomsAs estrogens are synthesized from androgens, symptoms of [[hypoestrogenism]] may be present in both sexes in cases of severe androgen deficiency.<ref (asname=":0" estrogens are synthesized from androgens)./>
 
==Causes==
Hypoandrogenism is caused primarily caused by either dysfunction, failure, or absence of the [[gonad]]s (''[[hypergonadotropic hypogonadism|hypergonadotropic]]'') or impairment of the [[hypothalamus]] or [[pituitary gland]] (''[[hypogonadotropic hypogonadism|hypogonadotropic]]''),. whichThis in turn can be caused by a multitude of different stimuli, including [[genetic condition]]s (e.g., [[gonadotropin-releasing hormone|GnRH]]/[[gonadotropin]] insensitivity and [[disorders of steroidogenesis|enzymatic defects of steroidogenesis]]), [[tumor]]s, [[Trauma (medicine)|trauma]], [[surgery]], [[autoimmunity]], [[radiation therapy|radiation]], [[infection]]s, [[toxin]]s, [[drug]]s, and many others. Alternatively, itIt may also be the result of conditions such as [[androgen insensitivity syndrome]] or [[hyperestrogenism]]. More simply, [[oldOld age]] may also be a factor in the development of hypoandrogenism, as androgen levels decline with age.<ref>{{CitationCite journal |last1=Barratt |first1=Christopher L R |last2=Björndahl |first2=Lars |last3=De Jonge |first3=Christopher J |last4=Lamb |first4=Dolores J |last5=Osorio Martini |first5=Francisco |last6=McLachlan |first6=Robert |last7=Oates |first7=Robert D |last8=van der Poel |first8=Sheryl |last9=St John |first9=Bianca |last10=Sigman |first10=Mark |last11=Sokol |first11=Rebecca |last12=Tournaye |first12=Herman needed|date=January2017-11-01 2015|title=The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance—challenges and future research opportunities |url=https://academic.oup.com/humupd/article/23/6/660/3979420 |journal=Human Reproduction Update |language=en |volume=23 |issue=6 |pages=660–680 |doi=10.1093/humupd/dmx021 |issn=1355-4786 |pmc=5850791 |pmid=28981651}}</ref>
 
==Diagnosis==
Diagnosis of androgenic deficiency in males should beis based on symptoms together with at least two measurements of testosterone done first thing in the morning after a period of not eating.<ref name=Bha2018/> In those without symptoms, testing is not generally recommended.<ref name=Bha2018>{{cite journal |last1=Bhasin |first1=S |last2=Brito |first2=JP |last3=Cunningham |first3=GR |last4=Hayes |first4=FJ |last5=Hodis |first5=HN |last6=Matsumoto |first6=AM |last7=Snyder |first7=PJ |last8=Swerdloff |first8=RS |last9=Wu |first9=FC |last10=Yialamas |first10=MA |title=Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. |journal=The Journal of Clinical Endocrinology and Metabolism |date=1 May 2018 |volume=103 |issue=5 |pages=1715–1744 |doi=10.1210/jc.2018-00229 |pmid=29562364|doi-access=free }}</ref> Androgen deficiency is not usually checked for diagnosis in healthy women.<ref name=Women2014>{{cite journal | vauthors = Wierman ME, Arlt W, Basson R, Davis SR, Miller KK, Murad MH, Rosner W, Santoro N | title = Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 99 | issue = 10 | pages = 3489–510 | date = October 2014 | pmid = 25279570 | doi = 10.1210/jc.2014-2260 | doi-access = free }}</ref>
 
Androgen deficiency is not usually a checked for diagnosis in healthy women.<ref name=Women2014>{{cite journal | vauthors = Wierman ME, Arlt W, Basson R, Davis SR, Miller KK, Murad MH, Rosner W, Santoro N | title = Androgen therapy in women: a reappraisal: an Endocrine Society clinical practice guideline | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 99 | issue = 10 | pages = 3489–510 | date = October 2014 | pmid = 25279570 | doi = 10.1210/jc.2014-2260 | doi-access = free }}</ref>
 
==Treatment==
{{See also|Testosterone (medication)}}
Treatment may consist of [[hormone replacement therapy]] with [[androgen]]s in those with symptoms.<ref name=Bha2018/> Treatment mostly just improves [[sexual function]] in males.<ref name=Bha2018/>
 
Alternatively, [[gonadotropinGonadotropin-releasing hormone]] (GnRH)/[[gonadotropin-releasing hormone agonist|GnRH agonist]]s or [[gonadotropin]]s may be given (in the case of ''hypogonadotropic'' hypoandrogenism). The [[Food and Drug Administration]] (FDA) stated in 2015 that neither the benefits nor the safety of [[testosterone (medication)|testosterone]] have been established for [[testosterone (medication)#Low levels due to aging|low testosterone levels due to aging]].<ref name=FDA2015>{{cite web |author=Staff |title=Testosterone Products: Drug Safety Communication -&nbsp;— FDA Cautions About Using Testosterone Products for Low Testosterone Due to Aging; Requires Labeling Change to Inform of Possible Increased Risk of Heart Attack And Stroke |url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm436280.htm |date=3 March 2015 |work=[[FDA]] |accessdate=5 March 2015 }}</ref> The FDA has required that testosterone pharmaceutical labels include warning information about the possibility of an increased risk of heart attacks and stroke.<ref name=FDA2015/>
 
{{Androgen replacement therapy formulations and dosages used in men}}
 
== See also ==
* [[Androgen]]▼
{{cmn|colwidth=30em|
* [[Hypogonadism]]
* [[Hyperandrogenism]]
* [[Hyperestrogenism]]
* [[Hypergonadism]]
* [[Hypoestrogenism]]
* [[HypergonadismHypogonadism]]
* [[HyperestrogenismLate-onset hypogonadism]]
▲* [[Androgen]]
}}
 
== References ==
{{Reflist}}
 
{{EndocrineGonadal pathologydisorder}}
 
[[Category:Endocrine gonad disorders]]
[[Category:Male genital disorders]]
[[Category:Animal reproductive system]]
[[Category:Intersex variations]]
Retrieved from "https://en.wikipedia.org/wiki/Androgen_deficiency"