Androstenedione, a precursor steroid hormone, is produced naturally in the adrenal glands and ovaries. While it is a normal part of female physiology, an imbalance in its levels can lead to noticeable health effects. Understanding this hormone’s function provides insight into how the body maintains its delicate hormonal balance.
The Role of Androstenedione in the Female Body
Androstenedione functions as an intermediate step in the body’s production of other sex hormones. It is a precursor to both testosterone, an androgen, and estrogen, a primary female sex hormone. Its synthesis occurs mainly in the adrenal glands and ovaries.
Androstenedione contributes to the development of secondary sex characteristics during puberty, such as hair growth in the pubic and underarm areas. It also plays a role in maintaining muscle and bone mass. In females, androstenedione can be converted into testosterone in peripheral tissues, contributing to androgen production, and can also be aromatized into estrogen. This balanced production is important for overall hormonal regulation.
Symptoms of High Androstenedione Levels
Elevated androstenedione levels, which lead to increased androgen activity, can cause a range of physical and reproductive signs. One common physical manifestation is hirsutism, characterized by excess, coarse hair growth in areas typically associated with male patterns, such as the face, chin, chest, abdomen, and back.
Another frequent sign is severe acne, particularly if it is persistent or appears in adulthood. Androgens stimulate oil glands in the skin, leading to increased sebum production and clogged pores. Androgenic alopecia, or male-pattern hair loss on the scalp, where hair thins at the crown and temples, may also occur. Some women might experience a deepening of their voice or an increase in muscle mass.
Reproductive health can be affected by high androstenedione levels. Women may experience irregular menstrual cycles, a condition known as oligomenorrhea, or even complete absence of periods, called amenorrhea. These irregularities often stem from anovulation, which is the lack of ovulation, and can contribute to difficulties with fertility.
Causes of Elevated Androstenedione
The most common cause of elevated androstenedione levels in females is Polycystic Ovary Syndrome (PCOS), accounting for approximately 70% to 90% of cases of hyperandrogenism. PCOS is an endocrine disorder characterized by hormonal imbalances, irregular periods, and often, the development of small cysts on the ovaries. In PCOS, chronically elevated levels of luteinizing hormone (LH) and insulin can lead to increased androgen production by the ovaries, including androstenedione.
Other medical conditions can also lead to increased androstenedione. Congenital Adrenal Hyperplasia (CAH), particularly its non-classic form, is a group of genetic disorders affecting the adrenal glands’ ability to produce certain hormones. This enzyme deficiency can result in the overproduction of androgen precursors, including androstenedione. Non-classic CAH often presents with symptoms similar to PCOS, such as irregular periods and hirsutism.
Less common, but more serious, causes of elevated androstenedione include adrenal tumors, which can be benign or malignant, and Cushing’s syndrome. Adrenal tumors can directly secrete excess androgens, leading to a sudden and rapid onset of symptoms. Cushing’s syndrome, caused by prolonged exposure to high levels of cortisol, can also lead to increased androgen production by the adrenal glands, resulting in symptoms like hirsutism and menstrual irregularities.
Testing and Managing Androstenedione Levels
Diagnosing elevated androstenedione levels typically begins with a blood test that measures the amount of androstenedione circulating in the bloodstream. For menstruating women, the timing of the blood sample collection may be specified, often in the early follicular phase of the menstrual cycle.
Management of high androstenedione levels primarily focuses on treating the underlying cause. For conditions like PCOS, lifestyle management, including dietary changes and regular physical activity, can help regulate hormone levels. If the cause is a specific medical condition, such as non-classic CAH, medication may be prescribed. Surgical intervention may be necessary for cases involving adrenal or ovarian tumors that are secreting hormones.
Beyond addressing the underlying cause, various medications manage symptoms associated with elevated androgens. Combined oral contraceptives are frequently used to regulate menstrual cycles and reduce androgen levels, improving acne and hirsutism. Anti-androgen medications, such as spironolactone, can also be prescribed to block androgen effects on target tissues, reducing symptoms like excessive hair growth and acne.