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Subdermal levonorgestrel implants: serum androgens.

Serum levels of androstenedione, dihydrotestosterone, and testosterone were determined by radioimmunoassay procedures in 25 female volunteers using subdermal levonorgestrel implants as a contraceptive. Mean serum androstenedione levels were increased after 1 and 6 months in comparison with preimplantation levels, the increase being significant only after 1 month. This could be attributed to increased production from the adrenal or ovaries and/or changes in clearance rate. Testosterone levels showed approximately 24% increase above basal values after 6 months' use of levonorgestrel implants, which was attributed to concomitant increases in androstenedione levels. The implication of these results is discussed.

Age Factors↗

[Steroidogenic function of the intra-arterial trophoblast in the rat. Ultrastructural, histoenzymologic and biochemical data].

The ultrastructural study of the intra-arterial trophoblast has revealed in the pregnant Rat a steroidogenic activity which has been confirmed by histoenzymologic observations (presence of delta 5-3 beta-HSDH and 17 beta-HSDH). At the 15th day postcoitum an in vitro investigation upon the metabolism of steroid hormone precursors suggests that the steroids (oestrogens, progestogens and androgens) secreted by the intra-arterial trophoblast have a local action upon the wall of the uterine placental arteries and are actively concerned with an important part upon the utero-placental hemodynamic as a whole.

Androstenedione↗

Interrelationship between excessive levels of circulating androgens in blood and ovulatory failure.

The association of excessive circulating androgens in blood and ovulatory failure in women is well documented in a variety of clinical conditions. The restoration of ovulatory function by wedge resection of the polycystic ovary, by the administration of glucocorticoids or removal of tumors of the adrenal or ovary--measures that also reduce the level of circulating androgens--is also well documented. In view of the many hypotheses of adrenal and ovarian abnormalities and disorders of the hypothalamic-pituitary axis in the human, resulting in hirsutism and ovulatory failure, a normal intact rat model was developed to study the effect of androgens on ovulation. The administration of a weak androgen, dehydroepiandrosterone (DHA), to immature rats resulted in a single precocious ovulation followed by ovulatory failure. The conversion of DHA to estrogens appeared to be the principle mechanism for the precocious ovulation. The steps appeared to be an elevation in blood estradiol, followed by the depletion of cytoplasmic estradiol receptors of the hypothalamus and pituitary and the gonadotropin surge leading to ovulation. These events appeared to be similar to those occuring in the adult cycling rat, in precocious puberty induced by the administration of pregnant mare serum gonadotropins and during the onset of natural puberty. The role of estrogens in inducing the precocious ovulation was further supported by the absence of precocious ovulation in animals in which the conversion of DHA to estrogens was blocked or by administering androgens that could not be converted to estrogens. In contrast, the subsequent ovulatory failure could not be explained entirely by the conversion of DHA to estrogens. There was a considerable time lag between the withdrawal of DHA treatment and the replenishment of pituitary and hypothalamic cytoplasmic estradiol receptors. Unlike those of the cycling animal, the receptors were not replenished when the levels of circulating estradiol in blood receded. The replenishment occurred only after the circulating levels of androstenedione, DNA and progesterone were reduced. Receptor replenishment in the hypothalamus and pituitary was followed by increases in the levels of circulating gonadotropins, particularly LH, with subsequent restoration of cyclic ovulatory function. The ovaries in the acyclic androgen-treated rat were responsive to gonadotropins. The pituitary responded to LH-RH administration, but the sensitivity was reduced. In the adult rat, ovulatory failure and the formation of polycystic ovaries took place with doses of DHA as low as 7.5 mg per kg of body weight. Attempts are being made to obtain further insights into the mechanism of androgen-induced ovulatory failure by studying the effect of androgens and progesterone on the steroid receptors and their function in the hypothalamus and the pituitary. Furthermore, a direct effect of DHA on the ovary, causing follicular atresia and cystic changes, is also being explored.

Animals↗

Gonadal function following vasectomy in the rat.

Adult rats were studied at four, eight, and 12 months following vasectomy and sham-operation. The weights of the seminal vesicles, ventral prostate, pituitary, and kidneys were not significantly affected by vasectomy. Testicular endocrine function in vasectotomized rat was transiently stimulated as witnessed by elevation in testicular venous testosterone and androstenedione after four months. There then occurred signs of decline in gametogenic function and atrophy of the testis after 12 months whereas hormonogenesis appeared to remain at normal levels. There was no alteration in the morphology of the epididymis at any of the time intervals of study after vasectomy.

Animals↗

The relevance of the pharmacologic properties of a progestational agent to its clinical effects as a combination oral contraceptive.

Levonorgestrel (LNg) is known for its marked progestational/contraceptive activity. As shown in animal experiments, however, high doses of LNg are required to elicit an androgenic response; in contrast, considerably lower doses of LNg are required for antiovulatory (contraceptive) action. Thus, a large dose separation exists between androgenic and contraceptive activity. When LNg is combined with an estrogen, as in the contraceptive formulations, the androgenic response is attenuated or negated. The results of recent clinical trials have demonstrated that the androgenic activity of LNg is not expressed at contraceptive doses, particularly when LNg is combined with ethinyl estradiol (EE), as in the low-dose monophasic/triphasic formulations (monophasic [Nordette]: 150 mcg LNg/30 mcg EE; triphasic [Triphasil/Trinordiol]: six days, 50 mcg LNg/30 mcg EE; five days, 75 mcg LNg/40 mcg EE; ten days, 125 mcg LNg/30 mcg EE). Clinical evidence from several trials confirms that sex hormone-binding globulin levels are increased, plasma androgen levels are decreased, and acne is markedly improved with the use of Triphasil and Nordette, suggesting a non-androgenic profile.

Acne Vulgaris↗

Clinical evidence of the minimal androgenic activity of norgestimate.

The goal in improving the progestational component of oral contraceptives (OCs) is to enhance the selectivity of the progestin by achieving a high degree of contraceptive efficacy while decreasing undesirable side effects associated with existing progestational agents. The androgenic activity of current progestins results in changes in lipid metabolism, particularly decreased levels of high-density lipoprotein cholesterol (HDL), which have been associated with an increased risk of coronary heart disease (CHD). A progestin with high antiovulatory activity and minimal androgenicity would offer a clear therapeutic advantage in oral contraception. Norgestimate (NGM) is a new progestin with a unique profile of biological activity that has demonstrated a high level of selectivity in preclinical assays. The present studies were conducted to confirm clinically the low androgenic activity of NGM. Norgestimate (0.25 mg) in combination with 0.035 mg ethinyl estradiol (NGM 0.25/35) was compared with 0.30 mg norgestrel combined with 0.030 mg ethinyl estradiol (Lo/Ovral) in two multicenter clinical studies. In the first study (1,261 women), HDL levels were significantly increased from baseline levels in NGM 0.25/35 subjects but were significantly decreased in Lo/Ovral subjects. Increases in low-density lipoprotein cholesterol (LDL) levels were moderate in the NGM 0.25/35 group and pronounced in the Lo/Ovral group. A favorable lipid profile in NGM 0.25/35 subjects was also reflected in the LDL/HDL ratios, which were significantly lower in the NGM 0.25/35 subjects than in the Lo/Ovral subjects. Sex hormone binding globulin (SHBG) binds androgens, preventing clinical expression of androgenic activity. As a result, elevations in SHBG levels reduce bioactive (unbound) androgen levels and decrease the potential for androgenic side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Acne Vulgaris↗

Androgen and estrogen formation in women with ovarian hyperthecosis.

Women with ovarian hyperthecosis were studied and found to have a plasma testosterone production rate of 2.1 mg/day, a value eight times greater than that of nonhirsute, ovulatory women. The severity of hirsutism and virilization in these women was more closely correlated with the amount of testosterone produced than with plasma testosterone concentrations. The mean plasma production rates of androstenedione in these women, 8.6 mg/day, was more than three times that found in young women with no evidence of androgen excess. There was a marked gradient between ovarian and peripheral venous plasma concentrations for both C19 steroids. Following ovarian wedge resection or oophorectomy, there was a precipitous fall in the peripheral venous concentrations of these steroids. These observations support the view that the major source of excess androstenedione and testosterone secretion in these subjects was the ovaries. The rate of estrone formation in these women, 106-345 microgram/day, was the result of extraglandular aromatization of plasma androstenedione.

Adolescent↗

Increased urinary androgen levels in patients with carcinoma in situ of the breast with onset while taking oral contraceptives.

Urinary testosterone, androstanediol, ethiocolanolone, and androsterone glucuronide were determined by use of gas chromatography in four patients with carcinoma in situ of the breast. In all the patients, one or more of these hormones were higher than normal. This finding supports previous reports from our laboratory of increased androgen excretion in patients with fibrocystic disease or infiltrating carcinoma of the breast. Carcinoma in situ arose while the four patients were taking oral contraceptives. The progestational component of the pill, a nonderivative of testosterone, may carry with it some androgenic properties. This fact and the discovery of increased androgen excretion levels in these four patients led us to suppose that androgens could play a role in the development of breast cancer.

Adolescent↗

Steroid hormone accumulation in human breast cyst fluid.

Elevated concentrations of peptide hormones have been described previously in human breast fluid. In the current study, the levels of cortisol, progesterone, testosterone, dihydrotestosterone, androsterone, androsterone sulfate, dehydroisoandrosterone, dehydroisoandrosterone sulfate, estradiol, estrone, estradiol sulfate, and estrone sulfate were measured. The levels of the four 17-ketosteroids and the two estrogen sulfates were markedly elevated over the plasma level, while that of the other compounds was the same or only slightly higher than the plasma levels of the same compounds.

Androgens↗