The age-associated decline of androgens in reproductive age and menopausal Black and White women

Context: The effect of race and obesity on the age-associated decline of androgens in reproductive-aged and menopausal women has not been well characterized. Objective: Our objective was to determine the impact of racial differences and body mass index (BMI) on the change in androgen levels during a woman's reproductive and early menopausal years. Design and Setting: We conducted a frequency-matched cross-sectional study at a tertiary academic medical center. Patients or Other Participants: Subjects included 260 healthy, nonhirsute and eumenorrheic, self-identified Black and White women, ages 15-60 yr. Interventions: A medical and reproductive history, physical exam, and blood sampling were determined in the fasting state during the early follicular phase. Main Outcome Measures: Serum levels of androgens or androgen metabolites (dehydroepiandrosterone sulfate, androstenedione, and total and free testosterone) and SHBG were measured and the BMI, the waist-to-hip ratio (WHR), and the basal insulin resistance estimated by the homeostasis model assessment for insulin resistance determined. Results: After controlling for differences in BMI, insulin resistance, and WHR, Black women had lower androgen levels than age-matched White women. All androgens, or androgen metabolites, declined similarly across the reproductive lifespan and menopausal transition in both Black and White women. Race was a significant predictor of dehydroepiandrosterone sulfate, androstenedione, and total and free testosterone but not SHBG. Conclusions: Eumenorrheic, nonhirsute Black women have a lower range of normal androgen levels than White women of the same age, BMI, WHR, and homeostasis model assessment index for insulin resistance. Race and age-adjusted data should be considered when evaluating androgen levels in women between the ages of 15 and 60 yr.