Androgens are a group of steroid hormones crucial for reproductive health in both sexes. Although often described as “male hormones,” androgens are present in all individuals, with testosterone being the most recognized example. When the body produces an excessive amount of these hormones, a condition known as hyperandrogenism occurs. This is a common endocrine issue, particularly affecting women of reproductive age.
Essential Functions of Androgens
Androgens are produced primarily by the testes in males, and by the ovaries and adrenal glands in females. These hormones are foundational for the onset of puberty and the development of secondary sex characteristics in both sexes. For all individuals, androgens contribute to maintaining bone density and muscle mass throughout life.
Androgens also play a role in red blood cell production and regulating sexual desire and function. In women, androgens serve as precursors that the body converts into estrogens, which are necessary for regulating the menstrual cycle and maintaining bone strength.
The adrenal glands contribute to the pool of androgens in the body, including dehydroepiandrosterone (DHEA) and androstenedione.
Physical Manifestations of Excess Androgen
The most noticeable signs of elevated androgen levels, especially in women, relate to changes in hair growth and skin condition. Hirsutism is a common symptom, characterized by the growth of hair in a male-pattern distribution, such as on the face, chest, abdomen, and back. This excessive hair growth affects a majority of women who experience hyperandrogenism.
High levels of androgens stimulate the oil glands in the skin, leading to increased sebum production, which causes oily skin and acne. Another distinct physical change is androgenic alopecia (male-pattern hair loss), which presents as thinning hair, particularly at the front and sides of the scalp. These hormones can disrupt the normal ovulatory cycle, resulting in menstrual irregularities like infrequent periods (oligomenorrhea) or the cessation of the menstrual cycle (amenorrhea).
In severe cases of hyperandrogenism, a process called virilization can occur, causing drastic changes. These signs may include a deepening of the voice, a reduction in breast size, and an increase in muscle mass. The rapid onset of virilization symptoms requires immediate medical evaluation.
Underlying Conditions Causing High Levels
Polycystic Ovary Syndrome (PCOS) is the most frequent cause of hyperandrogenism, accounting for 70% to 90% of cases. With PCOS, high levels of insulin and luteinizing hormone trigger the ovaries to produce an excess of androgens. The resulting hyperinsulinemia also reduces the liver’s production of sex hormone-binding globulin (SHBG), which further increases the amount of active, unbound testosterone in the bloodstream.
Another possible cause is Congenital Adrenal Hyperplasia (CAH), which is a group of genetic conditions that affect the adrenal glands. A partial enzyme shortage can disrupt the normal hormone production pathway, leading to an overproduction of androgens. Cushing’s disease, which results in an excess of the hormone cortisol, can also cause hyperandrogenism, as the underlying pituitary tumor may indirectly lead to the release of more adrenal androgens.
Androgen-secreting tumors of the ovaries or adrenal glands are a rare cause of high androgen levels. These tumors are often associated with the sudden development of hyperandrogenism symptoms. Certain medications, such as anabolic-androgenic steroids, can also be a source of increased androgens.
Confirming Diagnosis and Treatment Options
A medical professional begins the diagnostic process by taking a patient history, focusing on the onset and progression of symptoms like hirsutism and menstrual patterns. Blood tests are a primary tool for confirming a diagnosis. Key measurements include total testosterone and free testosterone, which is the unattached, biologically active form of the hormone.
Specialized blood tests may also check for dehydroepiandrosterone sulfate (DHEAS) to assess for adrenal involvement, and 17-hydroxyprogesterone to screen for non-classic Congenital Adrenal Hyperplasia. Imaging studies, such as a pelvic ultrasound, are performed to check for polycystic ovaries or to rule out an ovarian tumor. The specific treatment approach is determined by the underlying condition identified as the cause of the elevated androgen levels.
Pharmacological interventions include oral contraceptives, which help regulate the menstrual cycle and reduce androgen production. Anti-androgen medications, such as spironolactone, can be prescribed to block the effects of androgens on the body, reducing symptoms like acne and excessive hair growth. For women who are overweight or obese, especially those with PCOS, lifestyle modifications are an important part of management. A weight loss of 5 to 10% can significantly improve symptoms by decreasing insulin levels and lowering androgen concentrations.