Síndrome de insuficiencia androgénica en la mujer

  • Francisco Cóppola Centro Hospitalario Pereira Rossell, Hospital Pereira Rossell, Unidad de Climaterio, Coordinador, Clínica Ginecotocológica "C", Prof. Adj. Universidad de la República, Facultad de Medicina, Cátedra de Endocrinología, Ex Asistente. Sociedad de Endocrinología Ginecológica y Menopausia del Uruguay, Presidente
  • José Nader Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Hospital Pereira Rossell, Clínica Ginecotocológica "C", Docente Honorario. Clínica Ginecotocológica "C", Ex Asistente. Unidad de Climaterio, Coordinador. Sociedad de Endocrinología Ginecológica y Menopausia del Uruguay, Vicepresidente
  • Rafael Aguirre Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Hospital Pereira Rossell, Clínica Ginecotocológica "C", Docente Honorario. Clínica Ginecotocológica "C", Ex Asistente. Unidad de Climaterio. Sociedad de Endocrinología Ginecológica y Menopausia del Uruguay., Secretario


Los andrógenos cumplen importantes funciones fisiológicas en la mujer, sin embargo un síndrome de deficiencia androgénica es difícil de caracterizar y su tratamiento motivo de controversia. Generalmente se considera a los andrógenos como un elemento "nocivo" sobre la belleza y salud femeninas. Aunque cumplen importantes roles y en la posmenopausia constituyen el principal sustrato a partir del cual se sintetizan los estrógenos. Los escasos o antiguos conocimientos, o ambos, sobre el rol de los andrógenos en la mujer son uno de los problemas para optimizar el diagnóstico y el tratamiento. El presente artículo busca realizar una revisión de los conocimientos sobre los cambios del nivel de andrógenos con la edad y el uso de medicación, los caracteres de la insuficiencia androgénica en la mujer y las bases de la sustitución androgénica. Se busca optimizar el diagnóstico y el tratamiento del déficit androgénico en la mujer.


1) Demers LM. Biochemistry and laboratory measurement of androgens in women. In: Redmond GP, ed. Androgenic disorders. New York: Raven Press, 1995: 21-34.
2) Vermeulen A. Plasma androgens in women. J Reprod Med 1998 Aug; 43(8 suppl): 725-33.
3) Endoh A, Kristiansen SB, Casson RP, Buster JE, Hornsby PJ. The zona reticularis is the site of biosynthesis of dehydroepiandrosterone and dehydroepiandrosterone sulfate in the adult human adrenal cortex, resulting from its low expression of 3[beta]-hydroxysteroid dehydrogenase. J Clin Endocrinol Metab 1996; 81(10): 3558-65.
4) Burger HG, Dudley EC, Cui J, Dennerstein L, Hopper JL. A prospective longitudinal study of serum testosterone dehydroepiandrosterone sulphate and sex hormone binding globulin levels through the menopause transition. J Clin Endocrinol Metab 2000; 85(8): 2832-938.
5) Carlstrom K, Brody S, Lunell NO, Lagrelius G, Mollerstrom A, Pousette G, et al. Dehydroepiandrosterone sulphate and dehydroepiandrosterone in serum: differences related to age and sex. Maturitas 1988; 10(4): 297-306.
6) Ravaglia G, Forti P, Maioli F, Boschi F, Bernardi M, Pratelli L, et al. The relationship of dehydroepiandrosterone sulphate (DHEAS) to endocrine-metabolic parameters and functional status in the oldest-old. Results from an Italian study on healthy free-living over ninety-year-olds. J Clin Endocrinol Metab 1996; 81(3): 1173-8.
7) Longcope C. Adrenal and gonadal androgen secretion in normal females. Clin Endocrinol Metab 1986; 15(2): 213-27.
8) Vermeulen A, Verdonck L. Plasma androgen levels during the menstrual cycle. Am J Obstet Gynecol 1976; 125(4): 491-4.
9) Mushayandebvu T, Castracane DV, Gimpel T, Adel T, Santoro N. Evidence for diminished midcycle ovarian androgen production in older reproductive aged women. Fertil Steril 1996; 65(4): 721-3.
10) Vermeulen A. The hormonal activity of the postmenopausal ovary. J Clin Endocrinol Metab 1976; 42(2): 247-53.
11) Lobo RA. Androgens in postmenopausal women: production, possible role, and replacement options. Obstet Gynecol Surv 2001; 56(6): 361-76.
12) Roger M, Nahoul K, Scholler R, Bagrel D. Evolution with ageing of four plasma androgens in postmenopausal women. Maturitas 1980; 2(3): 171-7.
13) Keller ET, Ershler W, Chang C. The androgen receptor: a mediator of diverse responses. Front Biosci 1996; 1: d59-71.
14) Maclean HE, Warne GL, Zajac JD. Localization of functional domains in the androgen receptor. J Steroid Biochem Mol Biol 1997; 62(4): 233-42.
15) Moghissi E, Ablan F, Horton R. Origin of plasma androstanediol glucuronide in man. J Clin Endocrinol Metab 1984; 59(3): 417-21.
16) Zumoff B, Strain GW, Miller LK, Rosner W. Twenty-four hour mean plasma testosterone concentration declines with age in normal premenopausal women. J Clin Endocrinol Metab 1995; 80(4): 1429-30.
17) Longcope C. Hormone dynamics at the menopause. Ann NY Acad Sci 1990; 592: 21-30. Discussion 44-51.
18) Judd HL, Judd GE, Lucas WE, Yen SSC. Endocrine function of the postmenopausal ovary: concentrations of androgens and estrogens in ovarian and peripheral vein blood. J Clin Endocrinol Metab 1974; 39(6): 1020-4.
19) Labrie F, Belanger A, Cusan L, Gomez JL. Candas B. Marked decline in serum concentrations of adrenal C19 sex steroid precursors and conjugated androgen metabolites during aging. J Clin Endocrinol Metab 1997; 82(8): 2396-02.
20) Simpson ER, Rubin G, Clyne C, Robertson K, O’Donnell, L, Jones M, et al. The role of local estrogen biosynthesis in males and females. Trends Endocrinol Metab 2000; 11(5): 184-8.
21) Longcope C. Metabolism clearance and blood production rates of estrogen in postmenopausal women. Am J Obstet Gynecol 1971; 111(6): 779-85.
22) Judd HL, Lucas WE, Yen SCS. Effect of oophorectomy on circulating testosterone and androstenedione levels in patients with endometrial cancer. Am J Obstet Gynecol 1974; 118(6): 793-8.
23) Laughlin GA, Barrett-Connor E, Kritz-Silverstein D, Von-Muhlen D. Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study. J Clin Endocrinol Metab 2000; 85(2): 645-51.
24) Oldenhave A, Jaszmann LJB, Everaerd WTAM, Haspels AA. Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age. Am J Obstet Gynecol 1993; 168(3 Pt 1): 765-71.
25) Centerwall BS. Premenopausal hysterectomy and cardiovascular disease. Am J Obstet Gynecol 1981; 139(1): 58-61.
26) Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. JAMA 1992; 267(1): 64-9.
27) Sherwin BB, Gelfand MM. The role of androgen in the maintenance of sexual functioning in oophorectomized women. Psychosom Med 1987; 49(4): 397-409.
28) Roos NP. Hysterectomies in one Canadian province: a new look at risks and benefits. Am J Public Health 1984; 74(1): 39-46.
29) Tazuke S, Shaw K-T, Barrett-Connor E. Exogenous estrogen and endogenous sex hormones. Medicine (Baltimore) 1992; 71(1): 44-51.
30) Simon JA, Klaiber E, Wiita B, Bowen A, Yang HM. Differential effects of estrogen-androgen and estrogen-only therapy on vasomotor symptoms, gonadotropin secretion, and endogenous androgen bioavailability in postmenopausal women. Menopause 1999; 6(2): 138-46.
31) Casson PR, Elkind-Hirsch KE, Buster JE, Hornsby PJ, Carson SA, Snabes MC. Effect of postmenopausal estrogen replacement on circulating androgens. Obstet Gynecol 1997; 90(6): 995-8.
32) Shifren JL, Braunstein GD, Simon JA, Casson PR, Buster JE, Redmond GP, et al. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Engl J Med 2000; 343(10): 682-8.
33) Chetkowski RJ, Meldrum DR, Steingold KA, Randle D, Lu JK, Eggena P, et al. Biological effects of transdermal estradiol. N Engl J Med 1986; 314(25): 1615-20.
34) Masters WH, Johnson VE. Human sexual response. Boston: Little, Brown, 1966.
35) Davis SR, Tran J. Testosterone influences libido and well being in women. Trends Endocrinol Metab 2001; 12(1): 33-7.
36) Derman RJ. Effects of sex steroids on women’s health: implications for practitioners. Am J Med 1995; 98(1A): 137S-143S.
37) Graham CA, Ramos R, Bancroft J, Maglaya C, Farley TM. The effects of steroidal contraceptives on the well-being and sexuality of women: a double blind, placebo-controlled, two centre study of combined and progestogen-only methods. Contraception 1995; 52(6): 363-9.
38) Sanders SA, Graham CM, Bass J, Bancroft J. A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation. Contraception 2001; 64(1): 51-8.
39) Abraham GE. Ovarian and adrenal contribution to peripheral androgens during the menstrual cycle. J Clin Endocrinol Metab 1974; 39(2): 340-6.
40) Sherwin BB. Hormones, mood, and cognitive functioning in postmenopausal women. Obstet Gynecol 1996; 87(2 Suppl): 20S-6S.
41) Raisz L, Wiita B, Arthis A, Bowen A, Schwartz S, Trahiotis M, et al. Comparison of the effects of estrogen alone and estrogen plus androgen on biochemical markers of bone formation and resorption in postmenopausal women. J Clin Endocrinol Metab 1996; 81(1): 37-43.
42) Burger HG, Hailes J, Menelaus M, Nelson J, Hudson B, Balazs N. The management of persistent menopausal symptoms with oestradiol-testosterone: Clinical, lipid and hormonal results. Maturitas 1984; 6(4): 351-8.
43) Doldi N, Relvisi L, Bassan M, Fusi F, Ferrari A. Premature ovarian failure: steroid synthesis and autoimmunity. Gynecol Endocrinol 1998; 12(1): 23-8.
44) Anasti JN, Kalantaridou SN, Kimzey LM, Defensor RA, Nelson LM. Bone loss in young women with karotypically normal spontaneous premature ovarian failure. Obstet Gynecol 1998; 91(1): 12-5.
45) Miller K, Sesmilo G, Schiller A, Schonfeld D, Burton S, Klibanski A. Androgen deficiency in women with hypopituitarism. J Clin Endocrinol Metab 2001; 86(2): 561-7.
46) Masi AT, Feigenbaum SL, Chatterton RT. Hormonal and pregnancy relationships to rheumatoid arthritis: convergent effects with immunological and microvascular systems. Semin Arthritis Rheum 1995; 25(1): 1-27.
47) Wilder RL. Adrenal and gonadal steroid hormone deficiency in the pathogenesis of rheumatoid arthritis. J Rheumatol Suppl 1996; 44: 10-2.
48) Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281(6): 537-44. Erratum in JAMA 1999; 281(13): 1174.
49) Persky H, Lief AI, Strauss D, Miller WR, O’Brien CP. Plasma testosterone levels and sexual behavior of couples. Arch Sex Behav 1978; 7(3): 157-73.
50) Bancroft J, Sanders D, Davidson D, Warner P. Mood, sexuality, hormones, and the menstrual cycle. III. Sexuality and the role of androgens. Psychosom Med 1983; 45(6): 509-16.
51) McCoy N, Davidson J. A longitudinal study of the effects of menopause on sexuality. Maturitas 1985; 7(3): 203-10.
52) Flöter A, Nathorst-Böös J, Carlstrom K, von-Schoultz B. Androgen status and sexual life in perimenopausal women. Menopause 1997; 7(1): 95-100.
53) Myers LS, Dixen J, Morrissette D, Carmichael M, Davidson JM. Effects of estrogen, androgen, and progestin on sexual psychophysiology and behavior in postmenopausal women. J Clin Endocrinol Metab 1990; 70(4): 1124-31.
54) Bachmann GA, Leiblum SR, Kemmann E, Colburn DW, Swartzman L, Shelden R. Sexual expression and its determinants in the post-menopausal woman. Maturitas 1984; 6(1): 19-29.
55) Dennerstein L, Dudley EC, Hopper JL, Burger H. Sexuality, hormones and the menopausal transition. Maturitas 1977; 26(2): 83-93.
56) Cawood EHH, Bancroft J. Steroid hormones. The menopause, sexuality and well-being of women. Psychol Med 1996; 26(5): 925-36.
57) Dennerstein L, Smith AMS, Morse CA, Bourger HG. Sexuality and the menopause. J Psychosom Obstet Gynaecol 1994; 15(1): 59-66.
58) Hallstrom T. Sexuality in the climacteric. Clin Obstet Gynecol 1977; 4(1): 227-39.
59) Appelt H, Strauss B. The psychoendocrinology of female sexuality: a research project. Gynakologe 1986; 19(1): 11-8.
60) Nathorst-Böös J, von Schoultz B, Carlström K. Elective ovarian removal and estrogen replacement therapy-effects on sexual life, psychological well-being and androgen status. J Psychosom Obstet Gynaecol 1993; 14(4): 283-93.
61) Davis SR, McCloud P, Strauss BJG, Burger H. Testosterone enhances estradiol’s effects on postmenopausal bone density and sexuality. Maturitas 1995; 21(3): 227-36.
62) Arlt W, Callies F, van-Vlijmen JC, Koehler I, Reincke M, Bidlingmaier M, et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med 1999; 341(14): 1013-20.
63) Kasperk C, Helmboldt A, Borcsok J, Heuthe S, Cloos O, Niethard F, et al. Skeletal site dependent expression of the androgen receptor in human osteoblastic cell populations. Calcif Tissue Int 1997; 61(6): 464-73.
64) Zborowski JV, Cauley JA, Talbott EO, Guzick DS, Winters SJ. Bone mineral density, androgens and the polycystic ovary: the complex and controversial issue of androgenic influence in female bone. J Clin Endocrinol Metab 2000; 85(10): 3496-506.
65) Gregoriou O, Kouskouni E, Bakas P, Konidaris S, Papadias K, Kalovidouris A, et al. Bone mineral density in women with idiopathic hirsutism. Gynecol Endocrinol 2000; 14(5): 364-8.
66) Dixon JE, Rodin A, Murby B, Chapman MG, Fogelman I. Bone mass in hirsute women with androgen excess. Clin Endocrinol (Oxf) 1989; 30(3): 271-7.
67) Di-Carlo C, Shoham Z, MacDougall J, Patel A, Hall ML, Jacobs HS. Polycystic ovaries as a relative protective factor for bone mineral loss in young women with amenorrhea. Fertil Steril 1992; 57(2): 314-9.
68) Buchanan JR, Myers C, Lloyd T, Leuenberger P, Demers LM. Determinants of peak trabecular bone density in women: the role of androgens, estrogen and exercise. J Bone Miner Res 1988; 3(6): 673-80.
69) Steinberg KK, Freni-Titulaer LW, DePuey EG, Miller DT, Sgoutas DS, Coralli CH, et al. Sex steroids and bone density in premenopausal and perimenopausal women. J Clin Endocrinol Metab 1989; 69(3): 533-9.
70) Davidson BJ, Ross RK, Paganini-Hill A, Hammond GD, Siiteri PK, Judd HL. Total free estrogens and androgens in postmenopausal women with hip fracture. J Clin Endocrinol Metab 1982; 54(1): 115-20.
71) Cummings SR, Browner WS, Bauer D, Stone K, Ensrud K, Jamal S, et al. Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1998; 339(11): 733-8.
72) Savvas M, Studd JWW, Fogelman I, Dooley M, Montgomery J, Murby B. Skeletal effects of oral estrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women. Br Med J 1988; 297(6644): 331-3.
73) Aloia JF, McGowan DM, Vaswani AN, Ross P, Cohn SH. The relationship of menopause to skeletal and muscle mass. Am J Clin Nutr 1991; 53(6): 1378-83.
74) Kopera H. The history of anabolic steroids and a review of clinical experience with anabolic steroids. Acta Endocrinol Suppl (Copenh) 1985; 271: 11-8.
75) Bross R, Javanbakht M, Bhasin S. Anabolic interventions for aging-associated sarcopenia. J Clin Endocrinol Metab 1999; 84(10): 3420-30.
76) Franke WW, Berendonk B. Hormonal doping and andro-genization of athletes: a secret program of the German Democratic Republic government. Clin Chem 1997; 43(7): 1262-79.
77) Uzych L. Anabolic-androgenic steroids and psychiatric-related effects: a review. Can J Psychiatry 1992; 37(1): 23-8.
78) Bahrke MS, Yesalis CE. Psychological and behavioral effects of endogenous testosterone and anabolic-androgenic steroids. Sports Med 1990; 10(5): 303-37.
79) Labrie F, Diamond P, Cusan L, Gomez JL, Belanger A, Candas B. Effect of 12- month dehydroepiandrosterone replacement therapy on bone, vagina, and endometrium in postmenopausal women. J Clin Endocrinol Metab 1997; 82(10): 3498-505.
80) Engelson ES, Rabkin JG, Rabkin R, Kolter DP. Effects of testosterone upon body composition. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 11(5): 510-1.
81) Miller K, Corcoran C, Armstrong C, Caramelli K, Anderson E, Cotton D, et al. Transdermal testosterone administration in women with acquired immunodeficiency syndrome wasting: A pilot study. J Clin Endocrinol Metab 1998; 83(8): 2717-25.
82) Cutolo M, Seriolo B, Sulli A, Accardo S. Androgens in rheumatoid arthritis. In: Bijlsma JWJ, Linden S, van der Barnes CG, eds. Rheumatology Highlights 1995. Rheumatol Eur 1995; 24: 211-4
83) Malarkey WB, Strauss RH, Leizman DJ, Liggett M, Demers LM. Endocrine effects in female weight lifters who self-administer testosterone and anabolic steroids. Am J Obstet Gynecol 1991; 165(5 Pt 1): 1385-90.
84) Wilson JD. Androgen abuse by athletes. Endocr Rev 1988; 9(2): 181-99.
85) Tuiten A, Laan E, Panhuysen G, Everaerd W, de Haan E, Koppeschaar H, et al. Discrepancies between genital responses and subjective sexual function during testosterone substitution in women with hypothalamic amenorrhea. Psychosom Med 1996; 58(1): 234-41.
86) Riley A, Riley E. Controlled studies on women presenting with sexual drive disorder. I. Endocrine status. J Sex Marital Ther 2000; 26(3): 269-83.
87) Sherwin BB, Gelfand MM, Brender W. Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause. Psychosom Med 1985; 47(4): 339-51.
88) Casson PR, Carson SA, Buster JE. Testosterone delivery systems for women: present status and future promise. Semin Reprod Endocrinol 1998; 16(2): 153-9.
89) Sarrel P, Dobay B, Wiita B. Estrogen and estrogen-androgen replacement in postmenopausal women dissatisfied with estrogen-only therapy. Sexual behavior and neuroendocrine responses. J Reprod Med 1998; 43(10): 847-56.
90) Hickok LR, Toomey C, Speroff L. A comparison of esterified estrogens with and without methyltestoterone: Effects on endometrial histology and serum lipoproteins in postmenopausal women. Obstet Gynecol 1993; 82(6): 919-24.
91) Baulieu EE, Thomas G, LeGrain S, Lahlou N, Roger M, Debuire B, et al. Dehydroepiandrosterone (DHEA) DHEA sulfate and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci USA 2000; 97(8): 4279-84.
92) Stanczyk FZ, Shoupe D, Nunez V, Macias-Gonzales P, Vijod MA, Lobo RA. A randomized comparison of nonoral estradiol delivery in postmenopausal women. Am J Obstet Gynecol 1988; 159(6): 1540-6.
93) Javanbakht M, Singh AB, Mazer NA, Beall G, Sinha-Hikim I, Shen R, et al. Pharmacokinetics of a novel testosterone matrix transdermal system in health, premenopausal women and women infected with the human immunodeficiency virus. J Clin Endocrinol Metab 2000; 85(7): 2395-401.
94) Buckler HM, Robertson WR, Wu FC. Which androgen replacement therapy for women? J Clin Endocrinol Metab 1998; 83(11): 3920-4.
95) Lobo RA, March CM, Goebelsmann U, Krauss RM, Mishell DR Jr. Subdermal estradiol pellets following hysterectomy and oophorectomy. Effect upon serum estrone, estradiol, luteinizing hormone, follicle-stimulating hormone, corticosteroid binding globulin-binding capacity, testosterone-estradiol binding globulin-binding capacity, lipids, and hot flushes. Am J Obstet Gynecol 1980; 138(6): 714-9.
96) Wang C, Eyre DR, Clark R, Kleinberg D, Newman C, Irannanessh A, et al. Sublingual testosterone replacement improves muscle mass and strength, decreases bone resorption, and increases bone formation markers in hypogonadal man: A clinical research center study. J Clin Endocrinol Metab 1996; 81(10): 3654-62.
97) Modeska K. Tibolone for postmenopausal women: Systematic Review of Randomized Trial. J Clin Endocrinol Metab 2001; 87(1): 16-23.
98) Coppola FA, Nader JA. Tibolone review. Arch Gin Obstet 2003; 41: 24-8.
99) Phillips E, Bauman C. Safety surveillance of esterified estrogens-methylthestosterone (Estratest and Estratest HS) replacement therapy in the United States. Clin Ther 1997; 19(5): 1070-84.
100) Davis SR, Walker KZ, Strauss BJ. Effects of estradiol with and without testosterone on body composition and relationships with lipids in postmenopausal women. Menopause 2000; 7(6): 395-401.
101) Watts NB, Notelovitz M, Timmons MC, Addison WA, Wiita B, Downey LJ. Comparison of oral estrogens and estrogens plus androgen on bone mineral density, menopausal symptoms and lipid-lipoprotein profiles in surgical menopausal women. Obstet Gynecol 1995; 85(4): 529-37.
102) Sherwin BB, Gelfand MM, Schucher R, Gabor J. Postmenopausal estrogen and androgen replacement and lipoprotein lipid concentrations. Am J Obstet Gynecol 1987; 156(2): 414-9.
103) Farish E, Fletcher CD, Hart DM, Azzawi FA, Abdalla HI, Gray CE. The effect of hormone implants on serum lipoproteins and steroid hormones in bilaterally oophorectomized women. Acta Endocrinol (Copenh) 1984; 106(1): 116-20.
104) Sullivan ML, Martinez CM, Gennis P, Gallagher EJ. The cardiac toxicity of anabolic steroids. Progr Cardiovasc Dis 1988; 41(1): 1-15.
105) Yue P, Chatterkee K, Beale C. Testosterone relaxes rabbit coronary arteries and aorta. Circulation 1995; 91(4): 1154-60.
106) Gelfand MM, Ferenczy A, Bergeron C. Endometrial response to estrogen-androgen stimulation. In: Hamond CB, Haseltine FB, Seniff I, eds. Menopause evaluation, treatment and health concerns. New York: Alan R. Liss, 1989: 29-40.
107) Barrett-Connor E, Young R, Notelovitz M, Sullivan J, Wiita B, Yang HM, et al. A two-year, double-blind comparison of estrogen-androgen and conjugated estrogens in surgically menopausal women. J Reprod Med 1999; 44(12): 1012-20.
108) Dören M, Rubig A, Coelingh Bennink HJ, Holzgreve W. Differential effects on the androgen status of postmenopausal women treated with tibolone and continuous combined estradiol and norethindrone acetate replacement therapy. Fertil Steril 2001; 75(3): 554-9.
109) Doren M. Changes of DHEAS and SHBG from baseline: percent within 1 year, tibolone group. Fertil Steril 2001; 75(3): 559.
110) Modelska K, Cummings S. Female sexual dysfunction in postmenopausal women: Systematic review of placebo-controlled trials. Am J Obstet Gynecol 2003; 188(1): 286-93.
Cómo citar
Cóppola F, Nader J, Aguirre R. Síndrome de insuficiencia androgénica en la mujer. Rev. Méd. Urug. [Internet]. 31 de octubre de 2005 [citado 21 de mayo de 2022];21(3):174-85. Disponible en: http://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/801
Trabajos de Revisión o Actualización y Puestas al día