Dr. Sarrel explains who has problems with androgen deficiency.
We need to recognize that the women who most commonly are suffering from a deficiency of androgens are women who have lost the function of their ovaries, typically through surgery. In this country we have a situation called a surgical menopause. So this is not the natural ending of menstrual cycles at an average age of 51; this is typically at a younger age.
Twenty percent of all the women having hysterectomy in this country are 35 or younger, but about 600,000 women a year have a surgical menopause. That means they had a medical condition like hemorrhaging or fibroids or pain or infection or what’s called endometriosis, some of the most common problems, and EmpowHer has been excellent about bringing those issues to the fore and making women knowledgeable about them.
But when the surgery is done it typically solves the medical problem. However, the ovaries may be removed at the time of surgery, in which case half of all the androgens, and remember we said half was being made in the ovaries, they are gone overnight–boom, out the window. And typically, for hormone replacement a physician might replace the estrogen and forget about the androgens, which is not such a good idea.
On the other hand, replacing the estrogens is important, but we have an even bigger issue in this country right now, and that’s because of the national studies of hormones in post-menopausal women and the detrimental effects of hormones, even women having ovaries removed at a young age may go home from the hospital with a prescription for hormone therapy and never file the prescription.
We know that at the three-month point, after a hysterectomy and loss of ovaries, you’d expect 100 percent, especially young women would be replacing the missing hormones, but the figure is actually 25 percent because of fear and anxiety, which is unfounded in this age group, fear and anxiety about taking hormones and getting cancer or getting heart attacks and stroke. We will talk about that.
But the key issue here is to recognize the women who have the greatest needs, whether it be from a sexual point of view, a fatigue point of view, a mood point of view, anxiety and depression being the two big mood disorders, all of these women, the highest risks and bone loss, let’s not forget that, the highest risks are in the women who have a surgical menopause, loss of their ovaries and inadequate or no hormone replacement.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.