Sex hormone changes during weight loss and maintenance in overweight and obese postmenopausal African-American and non-African-American women

Rachael Z Stolzenberg-Solomon, Roni T Falk, Frank Stanczyk, Robert N Hoover, Lawrence J Appel, Jamy D Ard, Bryan C Batch, Janelle Coughlin, Xu Han, Lillian F Lien, Christina M Pinkston, Laura P Svetkey, Hormuzd A Katki, Rachael Z Stolzenberg-Solomon, Roni T Falk, Frank Stanczyk, Robert N Hoover, Lawrence J Appel, Jamy D Ard, Bryan C Batch, Janelle Coughlin, Xu Han, Lillian F Lien, Christina M Pinkston, Laura P Svetkey, Hormuzd A Katki

Abstract

Introduction: Changes in sex hormones with weight loss might have implications for breast cancer prevention but have not been examined extensively, particularly in African-American (AA) women.

Methods: We conducted a prospective study of 278 overweight/obese postmenopausal women (38% AA) not taking hormone therapy within the Weight Loss Maintenance Trial. All participants lost at least 4 kg after a 6-month weight-loss phase and attempted to maintain weight loss during the subsequent 12 months. We evaluated the percentage changes in estrone, estradiol, free estradiol, testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulfate and sex hormone-binding globulin (SHBG) using generalized estimating equations.

Results: In all study phases, AA women had higher levels of estrogen and testosterone concentrations, independent of adiposity. On average, participants lost 7.7 kg during the weight-loss phase, and concentrations of estrone (-5.7%, P = 0.006), estradiol (-9.9%, P <0.001), free estradiol (-13.4%, P <0.0001), and free testosterone (-9.9%, P <0.0001) decreased, while the SHBG concentration (16.2%, P <0.001) increased. Weight change did not significantly affect total testosterone or other androgen concentrations. Compared with non-AA women, AA women experienced less change in estrogens per kilogram of weight change (that is, per 1 kg weight loss: estrone, -0.6% vs. -1.2%, P-interaction = 0.10; estradiol, -1.1% vs. -1.9%, P-interaction = 0.04; SHBG, 0.9% vs. 1.6%, P-interaction = 0.006; free estradiol, -1.4% vs. -2.1%, P-interaction = 0.01).

Conclusion: To the best of our knowledge this is the first study to examine and compare the effects of intentional weight loss and maintenance on a panel of sex hormones in AA women and non-AA women. Although speculative, these data suggest hormonal differences may contribute to different racial patterns of breast cancer incidence and mortality and encourage further investigations to understand the long-term effects of weight loss on sex hormones in obese postmenopausal women.

Trial registration: ClinicalTrials.gov: NCT00054925.

Figures

Figure 1
Figure 1
Hormone concentrations by race in the Weight Loss Maintenance Trial, United States, 2003-2005. Estrone, estradiol, testosterone, and sex hormone binding globulin (SHBG) concentration by race in the Weight Loss Maintenance Trial, United States, 2003-2005. Mean hormone concentrations during weight loss and weight maintenance within race groups, and 95% confidence intervals from generalized estimating equations adjusted for age, physical activity, phase, and body mass index (kg/m2) at each time (0, 6, and 18 months). P values from a chi-square test on three degrees of freedom.

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