Androgen excess, or hyperandrogenism, is a medical condition caused by elevated levels of androgens. While often called “male hormones,” androgens like testosterone are produced and serve functions in all sexes. In females, the ovaries and adrenal glands produce these hormones, and this condition arises when that production becomes excessive, leading to various physical signs.
Symptoms of Androgen Excess
A common sign of hyperandrogenism is hirsutism, the growth of coarse, dark hair in a male-like pattern. This hair can appear on the face, chest, abdomen, and back. Its texture is thicker and more pigmented than the fine hair that normally covers the body.
Moderate to severe acne that persists beyond adolescence is another frequent symptom. High androgen levels stimulate the skin’s oil glands, increasing sebum production that can clog pores. This often results in more than occasional breakouts and can include deep, painful cystic acne.
Androgenic alopecia, or female-pattern hair loss, is another indicator. This presents as thinning hair, particularly at the crown, and may include a receding hairline at the temples. This scalp hair loss contrasts with the excessive body hair growth seen in hirsutism.
Elevated androgens can disrupt the menstrual cycle by interfering with ovulation. This can cause periods to become infrequent, irregular, or stop altogether (amenorrhea). In severe cases, virilization may occur, involving the development of features like a deepening voice, increased muscle mass, and reduced breast size.
Underlying Medical Causes
Polycystic Ovary Syndrome (PCOS) is the most prevalent cause of hyperandrogenism, accounting for 70-90% of cases. With PCOS, the ovaries produce excess androgens, often due to high insulin levels. High insulin stimulates the ovaries to make more testosterone and reduces the liver’s production of sex hormone-binding globulin (SHBG), increasing the amount of active, free testosterone in the blood.
Conditions affecting the adrenal glands are another source of androgen excess. Congenital Adrenal Hyperplasia (CAH) is a genetic disorder where an enzyme deficiency impairs cortisol production, causing the adrenal glands to overproduce androgens instead. A milder, “non-classic” form of CAH can cause hyperandrogenism that first appears in adolescence or adulthood.
Cushing’s syndrome, characterized by prolonged exposure to excess cortisol, can also cause high androgen levels. The pituitary gland may secrete too much adrenocorticotropic hormone (ACTH), overstimulating the adrenal glands. This causes them to release excess cortisol and androgens, leading to symptoms of hyperandrogenism.
Less commonly, tumors on the ovaries or adrenal glands can secrete androgens, causing a rapid and severe onset of symptoms, including virilization. These tumors are rare, but their presence is often signaled by this sudden development. Certain medications, like anabolic steroids, can also introduce excess androgens into the body.
The Diagnostic Process
Diagnosing androgen excess begins with a consultation to review the patient’s medical history and discuss symptoms like hair growth and menstrual changes. A healthcare provider will then perform a physical examination to visually assess and document these signs, such as quantifying hirsutism.
Blood tests are performed to confirm high androgen levels and investigate the cause. Key hormones measured include total and free testosterone, as well as dehydroepiandrosterone sulfate (DHEAS) to assess adrenal gland function. Other hormones, like 17-hydroxyprogesterone, may also be checked to screen for conditions such as CAH.
Imaging studies help identify the source of the hormone imbalance. A pelvic ultrasound can reveal signs of PCOS, like ovarian cysts, or detect an ovarian tumor. If an adrenal issue is suspected, a CT scan or MRI may be ordered to examine the adrenal glands for tumors or other abnormalities.
Management and Treatment Approaches
Treatment for androgen excess is tailored to the individual, focusing on managing symptoms and addressing the root cause. For many with PCOS, lifestyle interventions are foundational. Dietary changes and regular exercise aimed at weight management can reduce insulin resistance, which in turn helps lower androgen levels.
Hormonal contraceptives, such as combination birth control pills, are a common first-line therapy. These medications contain estrogen and progestin, which work together to suppress the ovaries’ androgen production. They also increase the liver’s production of SHBG, a protein that binds to testosterone and reduces its effects.
For persistent symptoms like hirsutism, anti-androgen medications such as spironolactone may be prescribed. This drug works by blocking androgen receptors in the skin and hair follicles. Other medications, like 5-alpha-reductase inhibitors, prevent the conversion of testosterone into its more potent form. If an androgen-secreting tumor is the cause, treatment involves its surgical removal.