Cited by 35Genetic and Clinical Aspects of Sex Determination and Chromosomal AbnormalitiesSexual Differentiation and DisordersHormonal and reproductive studies

Women with Turner syndrome are both estrogen and androgen deficient—the impact of hormone replacement therapy

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Viuff, Mette Hansen, Just, Jesper, Brun, Sara, Dam, Tine Vrist, Hansen, Mette, Melgaard, Lars, Hougaard, David M, Lappe, Michael +1 more·2022·The Journal of Clinical Endocrinology & Metabolism

Abstract

CONTEXT: Women with Turner syndrome (TS) suffer from hypergonadotropic hypogonadism, causing a deficit in gonadal hormone secretion. As a consequence, these women are treated with estrogen from the age of 12 years, and later in combination with progesterone. However, androgens have been given less attention. OBJECTIVE: To assess sex hormone levels in women with TS, both those treated and those nontreated with hormone replacement therapy (HRT), and investigate the impact of HRT on sex hormone levels. METHODS: At Aarhus University Hospital, 99 women with TS were followed 3 times from August 2003 to February 2010. Seventeen were lost during follow-up. Control group 1 consisted of 68 healthy age-matched control women seen once during this period. Control group 2 consisted of 28 young, eumenorrheic women sampled 9 times throughout the same menstrual cycle. Serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17β-estradiol, estrone sulfate, DHEAS, testosterone, free androgen index, androstenedione, 17-OH progesterone, and sex hormone-binding globulin (SHBG) were analyzed. RESULTS: All androgens, 17-OH progesterone, and sex hormone-binding globulin (SHBG) were 30% to 50% lower in TS compared with controls (P < 0.01). FSH, LH, and estrone sulfate were more than doubled in women with TS compared with controls (P < 0.02). Using principal component analysis, we describe a positive correlation between women with TS receiving HRT, elevated levels of SHBG, and decreased levels of androgens. CONCLUSION: The sex hormone profile in TS reveals a picture of androgen deficiency, aggravated further by HRT. Conventional HRT does not normalize estradiol levels in TS.

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  • Many young women with Turner syndrome benefit from a higher dose of estrogen than their older peers, exceeding 2 mg E2 orally or 50 mcg transdermally.

    “Many young women with TS benefit from a higher dose of estrogen than their older peers, that is, exceeding 2 mg E2 orally or 50 mcg TD.”
  • Higher estrogen doses are particularly important for achieving maximal uterine growth and development as options for fertility treatment increase.

    “This is particularly important for achieving maximal uterine growth and development as options for fertility treatment increase.”
  • Viuff et al. reported that E2 concentrations during hormone replacement therapy in Turner syndrome were comparable to controls only at early follicular phase, suggesting that the current regimen does not fully normalize E2 concentrations in Turner syndrome.

    “Viuff et al. reported that E2 concentrations during HRT in TS were comparable to controls only at early follicular phase suggesting that the current regimen does not fully normalize E2 concentrations in TS.”
  • It is not feasible to mimic the physiological cyclic variations of the adult woman with intact ovarian function.

    “As previously discussed, it is not feasible to mimic the physiological cyclic variations of the adult woman with intact ovarian function so all risks and benefits of options need to be considered.303”
  • Androgen concentrations are 30%-50% lower in women with TS than in controls.

    “Viuff et al. showed that androgen concentrations are 30%-50% lower in women with TS than in controls.303”

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Authors
Viuff, M. H., Just, J., Brun, S., Dam, T. V., Hansen, M., Melgaard, L., Hougaard, D. M., Lappe, M., & Gravholt, C. H.
Affiliations
  • Aarhus University Hospital (DK)
  • Aarhus University (DK)
  • Statens Serum Institut (DK)
  • CONNECT, Aarhus University Hospital , 8200 Aarhus , Denmark
Corresponding author
  • Viuff, Mette Hansen
  • Just, Jesper
Venue
The Journal of Clinical Endocrinology & Metabolism
Published
2022-03-18
Volume
107
Issue
7
Pages
1983-1993
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
OpenAlex
W4220716885
Cited by
35
References
42
Citations by year
2026: 3 · 2025: 13 · 2024: 11 · 2023: 6 · 2022: 2
FWCI
4.85
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Novo Nordisk Foundation (NNF15OC0016474, NNF20OC0060610)
  • Familien Hede Nielsens Fond
  • Independent Research Fund (0134-00406A)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
Keywords
Turner syndrome, hormone replacement therapy, androgen deficiency, estrogen deficiency, sex hormone levels, hypergonadotropic hypogonadism, sex hormone-binding globulin, estradiol, testosterone, dehydroepiandrosterone sulfate, androstenedione, luteinizing hormone, follicle-stimulating hormone, estrone sulfate
MeSH terms
Androgens, Estradiol, Estrogens, Female, Follicle Stimulating Hormone, Humans, Luteinizing Hormone, Progesterone, Sex Hormone-Binding Globulin, Gonadal Steroid Hormones, Testosterone, Turner Syndrome, Hormone Replacement Therapy

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