Androgens are a group of hormones present in both men and women, though associated more with male characteristics. These hormones, which include testosterone and androstenedione, play roles throughout the body. They contribute to development during puberty, support bone density, influence muscle mass, and regulate metabolism. When the body produces or processes an excess of these hormones, it creates an imbalance that can lead to a range of health concerns.
Manifestations of Elevated Androgens
Elevated androgen levels can lead to several physical changes, particularly in individuals assigned female at birth, where their baseline androgen levels are naturally lower. One common sign is hirsutism, involving the growth of coarse, dark hair in areas not typical for women, such as the upper lip, chin, chest, or abdomen. This pattern of hair growth indicates hormonal imbalance.
Acne, severe or persistent forms, also arises from excess androgens. These hormones stimulate the sebaceous glands in the skin, leading to increased oil production that can clog pores and promote breakouts. Hair thinning on the scalp, known as androgenic alopecia, presents as a receding hairline or diffuse thinning at the crown, mirroring male pattern baldness. Menstrual irregularities, such as infrequent, irregular, or absent periods, are common as high androgens can disrupt the normal ovulatory cycle.
Underlying Reasons for High Androgens
Polycystic Ovary Syndrome, or PCOS, is the most frequent cause of elevated androgens in women. This condition involves the ovaries producing an excess of androgens, often due to genetic factors and insulin resistance. The elevated insulin levels can stimulate ovarian cells to produce more testosterone and androstenedione, disrupting ovarian function and leading to anovulation.
Disorders of the adrenal glands can also contribute to increased androgen levels. Congenital Adrenal Hyperplasia (CAH) is a genetic condition where the adrenal glands lack enzymes for producing cortisol and aldosterone, leading to an accumulation of precursor hormones that become androgens. This results in an overproduction of adrenal androgens. Adrenal tumors, though less common, can also directly secrete androgens, leading to their elevation.
Ovarian tumors, while rare, can produce androgens and cause a rapid onset of symptoms. These tumors directly synthesize and release testosterone.
Certain medications can also influence the body’s androgen levels. Anabolic steroids directly increase circulating androgen concentrations. Other drugs may indirectly affect hormone metabolism or receptor sensitivity, leading to an increase in free or active androgen levels.
Identifying and Addressing High Androgen Levels
Identifying elevated androgen levels begins with a thorough physical examination and a review of symptoms. Healthcare providers will look for signs such as hirsutism, acne, or patterns of hair loss. This initial assessment helps guide further diagnostic steps.
Blood tests are a primary tool for confirming excess androgens. These tests measure specific hormone levels, including total testosterone, free testosterone, and dehydroepiandrosterone sulfate (DHEA-S). A blood test might also check for other hormones like luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to assess ovarian function, and prolactin. Imaging studies, such as an ultrasound of the ovaries, are performed to check for ovarian cysts associated with PCOS. If an adrenal cause is suspected, imaging of the adrenal glands may be used to look for tumors or hyperplasia.
Management of high androgen levels involves several approaches. Lifestyle modifications, including dietary changes and regular exercise, can be beneficial, particularly for individuals with PCOS, as these can improve insulin sensitivity and subsequently lower androgen production. For instance, weight loss of 5-10% can significantly improve hormonal profiles and symptoms in women with PCOS.
Medical treatments are used to address the hormonal imbalance and its symptoms. Oral contraceptives are prescribed to suppress ovarian androgen production and regulate menstrual cycles. Anti-androgen medications can block the effects of androgens at the receptor level, reducing symptoms like hirsutism and acne. For individuals with insulin resistance, medications like metformin can improve the body’s response to insulin, thereby decreasing ovarian androgen production in conditions like PCOS. The specific treatment plan is individualized, depending on the underlying cause and the severity of symptoms.