Androgens' role in the vagina as a source and target

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madman

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Estrogens are traditionally believed to be the main hormones for vaginal health, but research shows vagina is also affected by androgens. The lack of approved testosterone treatments for vaginal symptoms led to the use of prasterone, which provides local DHEA to vaginal tissues, introducing a new androgenic element to therapy.
 

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Table 1. Characteristics of androgens in women
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Adapted from Cipriani et al. [9]. DHEA, dehydroepiandrosterone; DHEAS, dehydroepiandrosterone sulfate; DHT, dihydrotestosterone.
 
Figure 1. Synthesis of androgens in women. Dehydroepiandrosterone (DHEA) represents the major androgen secreted by the adrenals, starting from cholesterol, by cytochrome P450 11 (CYP11) and CYP17. Testosterone is synthesized from cholesterol in the ovaries and adrenals, and from circulating DHEA in the peripheral tissues. Testosterone and androstenedione are aromatized by CYP19 into estradiol and estrone, respectively. Estrogens are considered a minor product of the adrenal glands. Interconversion between estradiol and estrone is mediated by isoforms of 17β-hydroxysteroid dehydrogenase (17β-HSD). In target tissue, 5α-dihydrotestosterone (5α-DHT) is synthesized from testosterone by 5α-reductase. Major pathways of synthesis are denoted by black arrows and minor by white arrows. Adapted from Traish et al. [10].
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