Testosterone and Visceral Fat in Midlife Women: The Study of Women's Health Across the Nation (SWAN) Fat Patterning Study

Abstract

Visceral fat (VF) increases with the menopause and is an independent predictor of the metabolic syndrome, diabetes, and cardiovascular disease (CVD) in women. Little is known about how hormonal changes during the menopausal transition are related to the increase in VF. We aimed to determine the relationship between bioavailable testosterone and VF in middle‐aged women at various stages of the menopausal transition and whether this relationship is independent of age and other CVD risk factors. The Study of Women's Health Across the Nation (SWAN) is a longitudinal, community‐based study. This report uses baseline data from a population‐based longitudinal ancillary study at the Chicago site to examine the cross‐sectional relationship between testosterone and computed tomography (CT)–assessed VF in women at different stages of the menopausal transition. Included are 359 women (47.2% black), aged 42–60 years, who were randomly selected from a complete community census in which a 72% participation rate was achieved. In multivariate models, bioavailable testosterone was associated with VF independent of age, race, percent total body fat, and other cardiovascular risk factors. Bioavailable testosterone was a stronger predictor than estradiol and was interchangeable in its strength of association with sex hormone–binding globulin (SHBG). As bioavailable testosterone was associated with VF even after adjusting for insulin resistance, this suggests that it plays an important role in regional fat distribution. Our findings may have direct implications in explaining the effect of menopause‐related testosterone predominance on VF accumulation and subsequent cardiovascular risk.

Prevalência de síndrome metabólica e seus componentes na transição menopáusica: uma revisão sistemática

“…De acordo com Janssen et al 13 , mulheres na pós-menopausa possuem maior acúmulo de gordura visceral do que as que ainda menstruam, sendo independente do processo de envelhecimento. O estrogênio é considerado como fator protetor para doenças cardiovasculares nas mulheres pré-menopáusicas, e devido à redução deste hormô-nio em mulheres após a menopausa ocorre maior suscetibilidade ao aumento de gordura na região abdominal.…”

Testosterone, SHBG and cardiovascular health in postmenopausal women

“…41,47 In another study, including pre-, peri-and postmenopausal women, high BT and low SHBG levels were also found to be associated with an increase in visceral fat, independently of age, insulin resistance and estradiol. 78 As all studies used a cross-sectional design, the causal direction of the reported associations cannot be ascertained. The reversal direction, for instance, is supported by studies showing a decrease in testosterone levels after weight and body fat loss in overweight women.…”

Androgenic sex steroids contribute to metabolic risk beyond intra‐abdominal fat in overweight/obese black and white women

“…However, some studies have shown that upon controlling for VAT, the relationship between metabolic variables and SHBG and/or bioavailable testosterone is no longer found (14)(15)(16). Furthermore, others have postulated that it is the bioavailable testosterone that regulates VAT accumulation associated with CVD risk, and may even directly contribute to CVD risk (10,17).…”

“…In the SWAN study (10), it was shown that bioavailable testosterone was the strongest predictor of VAT, whereas sex hormone-binding globulin (SHBG) was just as strong an inverse predictor of VAT, independent of race, total percent body fat, and other CVD risk factors. Given the strength of the relationship between VAT and bioavailable testosterone and its inverse relationship with SHBG, it would be important to determine if androgenic steroids have an independent effect on metabolic risk.…”