CLINICAL RELEVANCE OF TESTOSTERONE AND DIHYDROTESTOSTERONE METABOLISMIN WOMEN

Androgens are part of normal female physiology. When they are secreted in excess or when they cause unwanted symptoms such as hirsutism and male-pattern baldness, the term hyperandrogenism is used. In many hype randrogenic women, there is no well-defined hormonal abnormality, but the women are simply on one end of a normal spectrum of androgen secre tion and cutaneous androgen sensitivity. To be active in the skin, tes tosterone must be converted to dihydrotestosterone by the enzyme 5 alp ha-reductase. Androgen sensitivity is determined, in part, by 5 alpha- reductase activity in the skin. This is a localized phenomenon, and th ere is no generalized increase in 5 alpha-reductase activity in these women. Dihydrotestosterone can be converted to glucuronide and sulfate conjugates, including androstanediol glucuronide. These androgen conj ugates have been proposed to be serum markers of cutaneous androgen me tabolism, but recent evidence indicates that they arise from adrenal p recursors and are more likely to be markers of adrenal steroid product ion and metabolism. Antiandrogens (androgen receptor blockers) are the best medical treatment of cutaneous hyperandrogenism. 5 alpha-Reducta se inhibitors have recently been approved for the treatment of benign prostatic hyperplasia, and research is currently underway to determine their effectiveness in treating hirsutism and male-pattern baldness.