ESTROGEN-ANDROGEN· BALANCE IN·HIRSUTISM

FERTIUTY AND STERILITY Copyright © 1979 The American Fertility Society Vol. 32, No.3, September 1979 Printed in U.SA. ESTROGEN-ANDROGEN· BALANCE IN·HIRSUTISM CHUNG H. WU; M.D.* Department of Obstetrics and Gynecology, Uniuersity of Pennsyluania School of Medicine, Philadelphia, Pennsyluania 19104 Random blood samples were obtained from a group of patients having oligomenorrhea or secondary amenorrhea, who responded to progesterone with uterine withdrawal bleeding, associated with hirsutism (N = 35) or not associated with hirsutism (N = 9). A few blood samples were obtained during the midfollicular phase of normal cycles in age-matched normal females (N = 10) as controls for comparison. Plasma gonadotropins (follicle-stimulating hormone and luteinizing hormone [LHVand steroid hormones including testosterone (T), androstenedione (A), estradiol (E 2 ), estrone (E I ), and progesterone (P) were quantitated by radioimmunoassay. The percentage of free fraction of E 2 and T was determined by equilibrium dialysis at 37° C, and the percentage of T-E "binding globulin (TeBG}-bound fraction of E 2 and T was estimated by the specific steroid displacement-charcoal adsorption technique. The binding capacity of plasma TeBG was measured by the modified Scatchard plot technique. The E 2:T ratios of concentrations and the binding parameters were also evaluated. The weight (but not height) of hirsute females was significantly higher than that of normal females. Plasma LH, T, A, and E I levels were significantly elevated in hirsute females. Plasma T concentrations, including free, index, and total, correlated positively with degree of hirsutism. E 2:T ratios of concentration also suggested a similar, but negative, correlation. The percentage of free E2 increased more than the percentage offree T when the percentage of TeBG-bound E2 decreased more than the percentage of TeBG-bound T in hirsute females. The E2:T ratios of the percentage of free and TeBG-bound fractions did not show any correlation with degree of hirsutism. The T-binding capacity of plasma TeBG decreased in hirsute females and was also correlated significantly with degree of hirsutism. The elevated plasma T concentrations (including free, index, and total concentrations) in hirsute females overlapped significantly with that of normal females, thus they failed to discriminate each other. Fertil Steril 32:269, 1979 The testosterone (T) production rate in hirsute women is increased, 1 yet the T concentration in the peripheral blood of hirsute women is not always elevated. 1, 2This difference is explained by the increased T metabolic clearance rate, 1, 3 perhaps secondary to the decreased testosterone-estradiol- binding globulin (TeBG) in hirsute women. 3 Plasma TeBG concentration is influenced by estradiol (E2) and T. Elevated E2 stimulates TeBG Received February 16, 1979; accepted April 9, 1979. *Reprint requests: Dr. Chung H. Wu, Department ofObstet- rics and Gynecology, Hospital of the University ofPennsylva- nia, Philadelphia, Pa. 19104. 269 synthesis in the liver, thus peripheral TeBG concentration increases in the hyperestrogenic state; when T suppresses TeBG synthesis, the TeBG concentration in plasma decreases in the hyperan- drogenic state. TeBG, because of its high affinity for E2 andT, plays a significant role in controllhig the biologic activity of these two sex hormones. TeBG seems to amplify the biologic activity of E2 and T by a self-serving phenomenon. 4 Follicular hair growth is stimulated by androgen and sup- pressed by estrogen, 5 and a delicate estrogen- androgen balance may playa role in hair growth in hirsute women. A study was thus carried out to elucidate the estrogen-androgen balance in a group of hirsute women with menstrual disorders.

ESTROGEN-ANDROGEN· BALANCE IN·HIRSUTISM

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