Androgens are steroid hormones found in both sexes, though they are typically associated with male sexual development. They play a role in various bodily functions in women, including bone health, muscle development, and libido. Hyperandrogenism, or high androgen levels, refers to an excess of these hormones, a common hormonal imbalance that can affect women of reproductive age. This imbalance can disrupt normal bodily processes, leading to various physical symptoms.
Recognizing the Signs
High androgen levels in women often manifest as distinct physical changes. Hirsutism is a common symptom, characterized by the growth of coarse, dark hair in areas where women typically do not have prominent hair, such as the face, chest, abdomen, back, and inner thighs. Androgens stimulate hair follicles in these areas, leading to terminal hair development.
High androgen activity also leads to oily skin and acne, particularly severe or persistent forms. Androgens stimulate the sebaceous glands in the skin, leading to an overproduction of sebum, the oily protective secretion, which can clog hair follicles and contribute to acne. Another sign is androgenic alopecia, or male-pattern baldness, characterized by thinning hair or diffuse hair loss on the scalp.
High androgen levels can also disrupt ovarian function, leading to irregular menstrual periods, including cycles that are too frequent, infrequent, or absent. In severe cases, virilization can occur, where women develop male-associated traits. These signs include a deepening voice, decreased breast size, increased muscle mass, and enlargement of the clitoris.
Underlying Causes
The most common medical condition leading to elevated androgen levels in women is Polycystic Ovary Syndrome (PCOS). PCOS is an endocrine disorder where the ovaries produce excess androgens. In PCOS, elevated luteinizing hormone and insulin levels can increase ovarian androgen production.
Adrenal gland disorders can also contribute to high androgen levels. These include congenital adrenal hyperplasia (CAH), a group of genetic conditions where the adrenal glands overproduce androgens due to enzyme shortages. Cushing syndrome, caused by excessive cortisol, can also lead to increased adrenal androgen release.
While less common, certain tumors can also cause high androgen levels, including androgen-secreting tumors of the ovaries or adrenal glands. These tumors often lead to a rapid onset of severe hyperandrogenism symptoms. Certain medications, like anabolic-androgenic steroids, synthetic progestins, and antiepileptics, may also cause elevated androgen levels.
Diagnosis and Management
Diagnosing high androgen levels typically involves physical examination, laboratory tests, and imaging studies. A healthcare provider assesses symptoms like excessive hair growth or acne. Blood tests measure specific hormone levels, including total and free testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS). Total testosterone levels are often mildly elevated in PCOS, while significantly high levels might suggest an ovarian or adrenal tumor.
DHEAS is a marker for adrenal androgen production, with elevated levels indicating adrenal gland involvement. Measuring 17-hydroxyprogesterone levels can screen for congenital adrenal hyperplasia. Imaging tests, such as a pelvic ultrasound, identify ovarian cysts or tumors, while CT or MRI scans look for adrenal tumors. Hormonal contraception should be stopped for at least three months before testing, as it can suppress androgens and affect measurement accuracy.
Management strategies for high androgen levels aim to lower androgen production, reduce free androgen levels, or block androgen action. Lifestyle modifications, including diet and exercise, are recommended, particularly for conditions like PCOS where obesity and insulin resistance play a role. Weight loss can reduce symptoms caused by high androgen levels in PCOS.
Medications are frequently used to manage symptoms and address underlying causes. Combined oral contraceptives are a common treatment, reducing ovarian androgen production and increasing sex hormone-binding globulin (SHBG), which binds to testosterone and reduces its free levels. Anti-androgens, such as spironolactone, directly block androgen receptors and can reduce symptoms like excessive hair growth and acne. Insulin sensitizers, like metformin, may be prescribed, especially when insulin resistance is a factor, helping lower insulin levels and androgen production.
Broader Health Impact
Unmanaged high androgen levels can have several long-term health implications beyond visible symptoms. Women with hyperandrogenism, especially those with PCOS, face an increased risk of developing metabolic syndrome. This syndrome is a cluster of conditions that includes insulin resistance, which can progress to type 2 diabetes, elevated cholesterol levels, and abdominal obesity.
Cardiovascular issues are another concern, as high androgen levels are associated with an increased prevalence of cardiovascular risk factors, including hypertension and dyslipidemia. Evidence suggests a higher risk of conditions like coronary artery disease and myocardial infarction in women with hyperandrogenism. This risk may be influenced by factors such as abdominal fat accumulation and chronic low-grade inflammation.
High androgen levels can also lead to significant fertility challenges due to irregular or absent ovulation, making conception difficult. Addressing high androgen levels through diagnosis and appropriate management is important for reducing these health risks and improving overall well-being.