Androgens

What are androgens?

Androgens are a group of sex hormones. They help start puberty and play a role in reproductive health and body development.

Everyone has androgens. But people assigned male at birth (AMAB) naturally make more of them. Testosterone is the most common androgen.

The testicles in the male reproductive system and the ovaries in the female reproductive system make androgens. Your adrenal glands that sit on top of each kidney also produce these hormones.

Androgens are busy working behind the scenes to keep your body on track with sexual development and overall health. Their levels can change throughout the day. Different life stages, like puberty or menopause, affect hormone levels, as well.

Types of androgens

Testosterone is the main androgen in all people. The majority of other androgens play roles in making other hormones. For example, the following androgens help make testosterone and estrogen:

• Androstenedione
• Dehydroepiandrosterone (DHEA)
• DHEA sulfate (DHEAS)

Another androgen is dihydrotestosterone (DHT). As an adult, your body converts about 10% of your testosterone into DHT each day.

There are several other forms of androgens and androgen-related chemicals. The way your body uses these hormones is very complex.

What is the role of androgens?

In all people, androgens help with:

• Bone density
• Muscle development
• Puberty
• Red blood cell production (erythropoiesis)
• Sexual desire and function

What is the role of androgens in men?

In people with testicles (assigned male at birth), androgens contribute to:

• Deep voice (vocal cord lengthening)
• Getting taller
• Hair growth on your face, scalp, chest, underarms and genitals
• Sperm development

These body characteristics mainly begin in puberty. But testosterone has different roles in different life stages. Once you’re an adult, your testosterone levels naturally decline as you age.

What is the role of androgens in women?

In people with ovaries (assigned female at birth), other body chemicals convert testosterone into estradiol, a form of estrogen. Estradiol:

• Triggers the secondary sexual characteristics in puberty, like breast development and wider hips
• Regulates menstruation
• Aids conception and pregnancy
• Minimizes bone loss (osteoporosis)

The levels of estradiol you have vary in different life stages. In postmenopause, your body doesn’t make much estradiol.

What androgen conditions affect men?

Adults AMAB mainly have issues with low androgen or low testosterone (male hypogonadism). It can cause symptoms like low sex drive and erectile dysfunction.

For some people, androgens can fuel the growth of prostate cancer. You may take medications to lower your body’s natural production of androgens. Healthcare providers call this treatment for prostate cancer androgen deprivation therapy (ADT).

Androgens — mainly DHT — also play a role in male-pattern baldness (androgenic alopecia).

What androgen conditions affect women?

People AFAB mainly have issues with high levels of androgens (hyperandrogenism). The most common cause of hyperandrogenism is polycystic ovary syndrome (PCOS). Rarely, adrenal or ovarian tumors cause hyperandrogenism.

People with PCOS or high androgen levels may have:

• Acne
• Amenorrhea (missed periods) or abnormal menstruation
• Excessive hair growth (hirsutism) in certain parts of your body
• High blood pressure and high cholesterol
• Infertility
• Obesity

Androgens — specifically DHT — can also play a role in female pattern baldness.

What androgen conditions affect children?

Issues with androgen levels can lead to delayed or early (precocious) puberty in children. These each have several possible causes.

Androgen levels also play a role in disorders of sexual development. This is a group of nearly 60 different conditions in which a person has features of both sexes.

How do healthcare providers measure androgen levels?

For people AFAB, healthcare providers typically use the free androgen index (FAI) to check for high androgen levels. FAI starts with a blood test to measure:

• Total testosterone
• Free testosterone
• Sex-hormone-binding globulin (SHBG)

SHBG is a protein that carries androgens (testosterone and DHT) and estrogen in your blood. Your provider compares total testosterone to SHBG to find the amount of androgen in your blood.

For people AMAB, providers typically order testosterone blood tests to check for low testosterone levels.