You will sometimes hear about Progestins (the man made hormone they put into contraceptives) being described as ‘androgenic’ or ‘anti-androgenic’. But what exactly does this mean?

Androgens are a group of sex hormones generally associated with men, although some are also found naturally in women’s bodies in lower concentrations. Testosterone is the main hormone in this group.

A progestin is considered androgenic if it triggers an androgenic response in the body. Some progestins do trigger this response, as they are derived from testosterone, meaning they can bind with the androgen receptors in our cells.

Natural progesterone (the kind that our bodies make) is actually anti-androgenic, and the most recent generations of progestins have been developed in an attempt to create progestins that do not have an androgenic effect1

Progestins can be described as ‘androgenic’ or ‘anti-androgenic’ – but the reality is that they all fall somewhere between the two extremes. The table below summarises how ‘androgenic’ the progestins used in contraception are…

We should treat this table with some caution. Much of the data available is extrapolated from data obtained from experiments on rats and rabbits. It is also quite old. Much of the data is not for pre-menopausal women as the focus is on hormone therapy. It is also worth noting that the androgenic activity of different progestins changes according to individual, sex, whether or not the progestin is taken with an oestrogen and even the type of cell. Some do have specific androgenic effects in breast cancer cells, for example. Basically, it’s not very straightforward.

What do Androgens in contraception do to us?

High levels of androgens in women can cause a hormonal imbalance, which can lead to a number of problems, such as acne, excess body hair and balding. These can also be symptoms of Polycystic Ovary Syndrome, which can also cause high levels of androgens as well as irregular periods and problems with insulin sensitivity. Anti-androgenic progestins can suppress testosterone, which can help with these symptoms.

Androgenic progestins are known to cause a whole range of increased risks, from developing breast cancer, cardiovascular disease and venous thromboembolism to increased susceptibility to genital tract infections2,3,4.

Combining progestins with synthetic oestrogens

It’s because of their androgenic properties that many progestins are combined with synthetic oestrogens in an attempt to counteract these side effects. Oestrogen is known to have a protective effect against some of the cardiovascular risks associated with progestins5.

References

  1. Mathur R, Levin O, Azziz R. Use of ethinylestradiol/drospirenone combination in patients with the polycystic ovary syndrome. Therapeutics and Clinical Risk Management. 2008. 4(2):487-492. Available from: doi:10.2147/tcrm.s6864
  2. Regidor PA. The clinical relevance of progestogens in hormonal contraception: Present status and future developments. Oncotarget. 2018. 9(77):34628-34638. Available from: https://doi.org/10.18632/oncotarget.26015
  3. Vieira S, Ferriani RA, and others. Use of the etonogestrel-releasing implant is associated with hypoactivation of the coagulation cascade. Human Reproduction. 2007. Volume 22. Issue 8:2196–2201. Available from: https://doi.org/10.1093/humrep/dem153
  4. Louw-du Toit R, Perkins MS, Hapgood JP, Africander D. Comparing the androgenic and estrogenic properties of progestins used in contraception and hormone therapy. Biochemical and Biophysical Research Communications. 2017. 491(1):140-146. Available from: doi:10.1016/j.bbrc.2017.07.063
  5. Africander D, Verhoog N, Hapgood JP. Molecular mechanisms of steroid receptor-mediated actions by synthetic progestins used in HRT and contraception. Steroids. 2011. 76:636–652. Available from: doi: 10.1016/j.steroids.2011.03.001.

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