Hyperandrogenism

Hyperandrogenism happens when you have an excess amount of androgens in your body. These hormones help start puberty and play a role in reproductive health and body development.

Everyone produces androgens, but males naturally make much more than females. The most well-known androgen is testosterone. Androgens are mostly made in the testicles or the ovaries. Both sexes also make androgens in their adrenal glands. Hyperandrogenism affects about 5% to 10% of females of reproductive age. It’s less common in males.

The condition causes different symptoms based on your age and sex. It has several possible causes. There are several ways healthcare providers treat the condition.

Is hyperandrogenism the same as polycystic ovary syndrome?

No, but they’re related. PCOS is a common cause of hyperandrogenism in females. But it’s just one possible cause out of many. Hyperandrogenism can affect anyone, no matter their sex. PCOS only affects females.

Symptoms of hyperandrogenism

Hyperandrogenism has various symptoms depending on your sex and whether or not you’ve been through puberty.

You can have symptoms of hyperandrogenism even if your androgen levels look normal in a blood test. It’s also possible to have high androgen levels in your blood but not notice symptoms.

If these symptoms develop rapidly and suddenly, it’s important to see your healthcare provider as soon as possible. In this case, the cause is often an androgen-secreting tumor.

Symptoms of hyperandrogenism in females who haven’t gone through puberty include:

• Enlarged clitoris
• Acne and oily skin
• Excess body hair (hirsutism) that causes coarse, dark hair (not “peach fuzz”) on the upper lip, chin, chest, abdomen and/or back

Symptoms of hyperandrogenism in males who haven’t gone through puberty include:

• Enlarged penis
• Early or excess hair growth in the pubic area and armpits
• Deep voice

Symptoms of hyperandrogenism in adult females include:

• Acne and oily skin
• Excess body hair (hirsutism)
• Irregular periods
• Infertility
• Male pattern baldness

In adult males, the effects of hyperandrogenism depend on where the hormones come from — your adrenal glands or an outside source like anabolic steroid injections. High levels of adrenal androgens usually don’t cause obvious symptoms. But they can affect how the testicles work and may lead to infertility.

Hyperandrogenism causes

Hyperandrogenism happens when any of the organs or hormones that produce or release androgens aren’t working right. Possible causes include:

• Polycystic ovary syndrome (PCOS) — the most common cause
• Congenital adrenal hyperplasia
• Cushing disease
• Androgen-secreting tumors
• Certain medications

Polycystic ovary syndrome (PCOS)

With PCOS, high levels of luteinizing hormone and insulin cause your ovaries to make more androgens. High insulin levels (hyperinsulinemia) prevent your liver from making a protein called SHBG. Without SHBG, you have more testosterone in your blood. This results in increased levels of free testosterone in your blood.

Approximately 80% to 90% of females with hyperandrogenism have PCOS.

Congenital adrenal hyperplasia (CAH)

CAH is a group of genetic conditions affecting your adrenal glands.

A genetic change causes the body to have low levels of certain enzymes needed to make important hormones. When these enzymes are low, the adrenal glands can make too much testosterone.

Some people have a milder form of this condition with just a partial enzyme shortage.

Cushing disease

Cushing disease is a type of Cushing syndrome. It happens when your body has too much cortisol.

Cushing disease happens when a noncancerous tumor in your pituitary gland makes too much ACTH, a hormone that tells your body to produce cortisol. This extra ACTH also makes your adrenal glands release more androgens.

Androgen-secreting tumors

Certain adrenal tumors and tumors in your ovaries or testicles can produce and release androgens. Hyperandrogenism from these kinds of tumors is rare, but is often very severe and sudden. This causes higher-than-normal androgen levels in your body.

Hyperandrogenism due to ovarian or adrenal tumors is rare. See your provider right away if you have sudden symptoms of hyperandrogenism.

Certain medications

Certain medications can cause hyperandrogenism:

• Anabolic-androgenic steroids
• Synthetic progestins
• Antiseizure medication

Risk factors

Hyperandrogenism can affect both children and adults. But it more commonly affects females of reproductive age.

Since PCOS is one of the most common causes in females, reducing your risk of PCOS can help. There isn’t one proven way to do this, but maintaining a healthy weight and exercising regularly can help.

Another risk factor for hyperandrogenism is obesity, which can increase insulin resistance.

Complications

Left untreated, hyperandrogenism can lead to complications like:

• Infertility
• Type 2 diabetes
• High blood pressure
• Heart disease

How doctors diagnose hyperandrogenism

Your healthcare provider will perform a physical exam to check for signs of the condition, like excessive body hair growth.

They’ll also ask you several questions about your medical history, including:

• Your age when your breasts started to develop
• Your age when you started to grow pubic hair
• Your age when you had your first period
• The frequency, length and heaviness of your periods
• If you’ve used anabolic steroids or testosterone

If your provider suspects hyperandrogenism, they’ll order blood tests to measure certain hormone levels:

• Total testosterone: This is the total amount of all the testosterone in your bloodstream. Total testosterone levels are often mildly elevated in those with PCOS. Highly elevated levels may indicate an ovarian or testicular tumor.
• Free testosterone: This testosterone is unattached to any proteins and is a small percentage of the total testosterone. Free testosterone levels may be elevated in those with PCOS.
• Androstenedione: Androstenedione is a steroid hormone that acts like androgen hormones in your body. Elevated levels may indicate PCOS.
• Dehydroepiandrosterone sulfate (DHEAS): A mildly elevated DHEAS level is common with PCOS. Highly elevated levels may indicate an adrenal tumor.
• 17-hydroxyprogesterone: This screens for non-classic congenital adrenal hyperplasia.

Your provider may order additional blood tests to rule out other possible causes of your symptoms. They may also order the following imaging tests:

• Pelvic ultrasound to look for ovarian cysts or tumors
• CT scan or MRI to look for adrenal tumors

How is hyperandrogenism treated?

Providers treat hyperandrogenism by lowering the amount of androgens in the body. This can usually be accomplished by blocking the effects of androgens or by preventing your ovaries or adrenals from producing them.

Many people see their provider to help with symptoms like excess hair growth, acne or irregular periods.

Medical treatment for hyperandrogenism

The medical treatment depends on its cause. For example:

• Corticosteroids: They can help with adrenal hyperandrogenism.
• Birth control pills: They can help treat acne, hirsutism and irregular periods.
• Spironolactone: This drug blocks the effects of androgens and helps with hormonal acne and excessive body hair.
• Cyproterone: This medication can help treat PCOS, reduce testosterone levels and reduce the production of acne-causing oils.
• Meformin: This medication can be useful if you have PCOS.

Surgery can be a treatment for ovarian, testicular or adrenal tumors. Sometimes, stopping a medication or switching to a different medication can help (if medication is the cause).

Treatment of hyperandrogenism symptoms

You can also seek treatment that improves your symptoms:

• Acne: Treatment for acne includes topical anti-acne agents, oral antibiotics like tetracycline, birth control pills and isotretinoin pills.
• Hirsutism: Treatment for excess hair could involve waxing, shaving and laser hair removal. Birth control pills can also help. A medication called spironolactone blocks the effects of excess androgens.
• Irregular periods: Taking hormonal birth control can be a treatment for irregular periods.

Is it reversible?

It’s not completely reversible, but you can manage the symptoms it causes.

When should I see my healthcare provider?

If you’re taking medication, you’ll likely need to see your healthcare provider regularly to make sure your treatment is working.

What can I expect if I have this condition?

The outlook for hyperandrogenism is good. Treatment is usually lifelong. But with the right care and treatment, you can manage its effects. Work closely with your healthcare provider. It may take several tries to find the right combination of treatments that work for you.

The signs and symptoms of hyperandrogenism can affect your self-esteem and mental health. It’s important to see a psychologist if you’re experiencing stress and/or depression due to these symptoms.