Abiraretone is a potent inhibitor of CYP17A1, required for the synthesis of gonadal and
adrenal androgens. Combined use of abiraterone with glucocorticoids can effectively lower androstenedione and testosterone metabolites in adult women with 21OHD without any potential side effects including hypertension and hypokalemia.
Thijssen, "
Adrenal androgen secretion and metabolism in postmenopausal women," in
Adrenal Androgens, A.
Monitoring of Glucocorticoid Replacement and
Adrenal Androgen Suppression
Aging accounts for much of the reduction in both ovarian and
adrenal androgen production, but natural menopause does not result in an abrupt decline in testosterone production.
At baseline, women with FSD had significantly decreased levels of testosterone and
adrenal androgen precursors (dehydroepiandrosterone-sulfate, or DHEA-S) but not ovarian androgen precursors (androstenedione), compared with women with normal sexual function.
Prolactin has a direct effect on
adrenal androgen secretion.
Combined oral contraceptives reduce levels of androgen, especially testosterone, by inhibiting ovarian and
adrenal androgen synthesis and by increasing levels of sex hormone-binding globulin (SHBG).
In males, the testes secrete approximately 95% of testosterone and the rest is made from
adrenal androgen precursors by the peripheral conversion (in liver, skin, and adipose tissue) of androstenedione.
Low-dose glucocorticoids work by suppressing
adrenal androgen production.
(6) Additionally, methyltestosterone prevents suppression of
adrenal androgen synthesis by estrogen treatment alone, thus allowing for enhanced peripheral androgen bioconversion to estrogen.
In addition to increased androgen synthesis in the ovary, there is a significant increase in
adrenal androgen levels seen in many women with PCOS.
(13) Little data exist about the effects of use of exogenous
adrenal androgen alone on BMD.
