H. P. G. Schneider

Androgens and Antiandrogens

Abstract: The role of androgens in womens health has been generally neglected. Currently available assays are lacking in sensitivity and reliability at the lower ranges. Circulating androgens as prohormones for other steroids (e.g., androgens) have an ubiquitous role on diverse physiological and behavioral systems. Clinical assessment of both androgen production and androgen availability can be achieved by measurement of two or three essential values. These include either total T and sex‐hormone binding globulin (SHBG), free T and SHBG, or free T and total T. The free testosterone index (total T/SHBG) correlates well with free or bioavailable T and can be used as a substitute. DHEA‐S is the most useful measure of adrenal androgen production in women. Androgen insufficiency in women is not a specific consequence of natural menopause, but may occur secondarily to the age‐related decline in both adrenal and ovarian androgen production. Since estrogen effects are also strongly linked to mood, psychological well‐being, and sexual function in women, the diagnosis of androgen insufficiency should only be made in women who are adequately estrogenized. Before initiating a trial of androgen replacement therapy, a comprehensive clinical assessment should be performed in all cases. Approved androgen replacement therapy is not yet available in most countries for treatment of female sexual dysfunction. This would include T supplements or DHEA. Several new progestins have been synthesized in the last decade. Dienogest is a hybrid progestin that is derived from both the pregnane and the estrane groups with a 17α‐cyanomethyl radical; drospirenone is derived from spirolactone. Somehow, the molecules available have demonstrated antiandrogenic properties. Cyproterone acetate (CPA) is the most potent antiandrogenic progestin, followed by dienogest, drosperinone, and chlormadinone acetate. Nomegestrol acetate and medrogestone also exert some antiandrogenic properties and are similar to chlormadinone acetate in antiandrogenic potency. While androgens act positively on libido in women, antiandrogenic properties in doses used in HRT do not appear to have a negative effect. Progestins used in HRT have varying pharmacological properties that are associated with different adverse effects. The new progestins with antiandrogenic properties avoid many of the androgenic side effects related to testosterone‐derived progestins. They also have the potential of not counteracting beneficial estrogen effects, for example, on the cardiovascular system or mental tone.

Hormone therapy: the European women's perspective

Objectives: To identify and describe the knowledge and attitudes of European women towards hormone therapy (HT) and to determine the key data of HT use in Europe. Methods A total of 8012 women aged 45-75 years were interviewed via standardized computer-aided telephone interviewing. The main outcome measures were history of HT use, opinions and knowledge of HT, reasons for HT use or for the rejection of it. Results: A total of 73% of all interviewed women were aware of HT as a treatment option for menopausal symptoms; 16% were currently using HT, 16% were former users and 68% of respondents had never used an HT product. The most frequently mentioned benefit of HT was relief of hot flushes (22%), followed by improvement of general well-being and quality of life (17%) and prevention of osteoporosis (16%). Cancer, and particularly breast cancer, was considered as a major risk of HT by 35% of the women. Ranking second in risks was weight gain (10%), followed by thrombosis or blood clots (7%). Conclusions: The findings of this survey demonstrate the preponderant differences in awareness of benefits and risks in HT users. To a large extent, users are satisfied with their HT and willing to pursue its use for longer periods of time.

Frauenheilkunde und Geburtshilfe

Die Entwicklung und die baulichen Veränderungen der FrauenkliF1ik der Universität Gießen waren eng mit ihrem Auftrag verknüpft, die Krankenversorgung und Lehre sicherzustellen sowie durch Forschung den Erkenntnisstand auf diesem speziellen Fachgebiet zu erweitern. Rudolph Kaltenbach (18821885) erwirkte vor seiner Berufung nach Halle die Genehmigung zum Bau einer neuen Klinik am Seltersberg, da die alte Klinik in der Nähe des Botanischen Gartens den steigenden Erfordernissen sowohl in der Versorgung der Pa tienten wie auch in der Lehre nicht mehr gerecht wurde. Unter Max Hofmeier (18851888) erfolgte der Baubeginn, und 1890 konnte unter Hermann Löhlein (18881901) die Klinik, die dem heutigen Mitteltrakt entsprach, nach dreijähriger Bauzeit eingeweiht werden. Eine Erweiterung der Klinik erfolgte durch den Anbau des Nordflügels unter Otto von Franque (190frl912) und durch den Anbau des Südflügels 1920 durch Rudolf Theodor Edler von Jaschke. In den nachfolgenden Jahren hat die Klinik keine weiteren wesentlichen baulichen Veränderungen erfahren. Durch einen Bombenangriff am 6. Dezember 1944 wurde die Frauenklinik der Universität Gießen nahezu völlig zerstört. Eine Bombe hatte den Mitteltrakt der Klinik bis auf die Grundmauern vernichtet, und die Seitenfügel der Klinik zu Ruinen ge-

Pulsed estrogen exposure selectively modulates tissue response: a hypothesis.

All postmenopausal hormone replacement therapies (HTs) aim to provide a steady mid-follicular serum concentration of estrogen, with the exception of pulsed estrogen therapy, which concentrates hormone exposure in the few hours following administration. This alteration in the kinetics of estradiol exposure does not change the beneficial effect of HT on climacteric symptoms or bone loss, but does reduce the stimulation of the breast and uterus leading to less mastalgia and bleeding. The following hypothesis provides a plausible pharmacological explanation as to how estradiol kinetics can selectively modify tissue response. Pulsed estradiol exposure influences the relative abundance of estrogen receptors (ERs) α and β, via a tissue-dependent non-genomic signaling pathway, resulting in selective upregulation and activation of ERβ in breast and endometrium, but not in bone. In addition, pulsed estrogen exposure also increases local concentration of 2-methoxyestradiol, a specific estradiol metabolite with proven anti-tumor properties.