Androgens and genitourinary syndrome of the menopause. Why, when and for whom they could be indicated


Androgeni e sindrome genitourinaria della menopausa. Perché, quando e per chi sono indicati
La Rivista Italiana di Ostetricia e Ginecologia, 2021, 1, 7-20
Why androgens – testosterone and dehydroepiandrosterone (DHEA) – can play a role in the treatment of the Genitourinary Syndrome of the Menopause? What evidence supports this? Androgens are essential sex hormones for women’s health.
Biological evidence (“bio-evidence”) indicates the following: androgens reach high plasma levels in childbearing age; have cell receptors in major organs; the hormone-receptor interaction mediates androgen-mediated, somatic (brain, muscle, bone), sexual and reproductive functions; their deficiency causes symptoms of androgenic insufficiency. They have a trophic, sexual, anti-inflammatory, and reconstructive functions. DHEA launches puberty (adrenarche). Androgens reach their plasma peak at twenty years of age, then they undergo an age-dependent gradual fall. At the age of fifty, women have lost about 50% of testosterone and 60-70% of DHEA. Bilateral ovariectomy reduces testosterone by 80%. Their age-dependent reduction, worsened by estrogen deficiency, contributes to systemic and genital aging and to the “low grade inflammation” typical of post-menopause.
Genitourinary Syndrome of the Menopause includes vulvo-vaginal symptoms (dryness, burning, itching, leucorrhea); sexual (vaginal dryness, coital pain/dyspareunia, sexual dysfunction) and urinary (urgency, dysuria, cystitis). GSM symptoms are caused by a chronic and destructive inflammatory process that involves the full thickness of genitourinary structures.
The aim of the work is to analyze why androgens can optimize therapeutic choices for the genitourinary syndrome of menopause and the genital health of women. Special focus will be devoted to the advantages of local therapies, with testosterone creams (propionate or vegetal origin) and/or with prasterone vaginal ovules, which combine efficacy, safety, and ease of use.

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