Adrenal and ovarian androgen
The differential role that the adrenals and the ovaries play in this androgen transition may also be less than clear (Figure 3.4). Classically, the postmenopausal ovary is felt to be a gonadotropinresponsive, androgen-secreting organ: thus preservation, if possible, may be beneficial to women in the long run.63 Couzinet et al. refuted this view in 2001 with a small study of adrenally compromised women either naturally postmenopausal or after oophorectomy and compared them with normal, postmenopausal, or oophorectomized controls. In their analysis, very low to undetectable levels of total testosterone, free testosterone, androstenedione, and DHEA were seen in the adrenal insufficiency cohort regardless of the presence or absence of ovaries. Those women with normal adrenal function had similar androgen levels regardless of ovarian status. No response was measured after hCG administration, and immunohistologic evaluation revealed low to absent levels of both steroidogenic enzymes and LH / FSH receptors.