When to suspect androgen deficiency other than at menopause.

OBJECTIVE To review causes of female androgen insufficiency (FAI) other than menopause. DESIGN A review of the available literature in this field. RESULT(S) Androgen levels decline with increasing age during the reproductive years in healthy women and vary little or not at all across menopause, with controversy as to whether levels change in the postmenopausal years. Thus the premenopausal decline in androgens potentially is the most common cause of female androgen insufficiency (FAI), whereas natural menopause in itself is not a cause of androgen deficiency. Pathophysiological causes of FAI can be divided into those that affect ovarian androgen production, those that affect adrenal androgen production, and combined deficiency states. Surgical menopause is characterized by an abrupt onset of symptoms, in contrast to a more insidious onset of relatively nonspecific symptoms in women who have FAI due to aging. CONCLUSION(S) The decline in testosterone with normal aging before menopause may well be the most common cause of FAI, although many women do not present with symptoms and most are not diagnosed until they have reached menopause.