Hyperandrogenism happens when you have an excess amount of androgens (a group of sex hormones) in your body. It most commonly affects people assigned female at birth and can cause hirsutism, acne and irregular periods.
Hyperandrogenism happens when you have an excess amount of androgens in your body. Androgens are a group of sex hormones. They help start puberty and play a role in reproductive health and body development.
Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, muscles and other tissues. These signals tell your body what to do and when to do it.
Everyone makes androgens, but men or people assigned male at birth (AMAB) make more of them. Women or people assigned female at birth (AFAB) make about one-twelfth the amount of androgens of people AMAB. 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, which sit on top of each of your kidneys, also produce these hormones. Other tissues, such as fat and skin, play roles in converting weak androgens into more potent (powerful) ones.
Hyperandrogenism causes different symptoms based on your age and sex. It has several possible causes and can be treated.
While hyperandrogenism and polycystic ovary syndrome (PCOS) are closely connected, they’re not the same thing.
Hyperandrogenism is the defining sign of PCOS, a hormonal imbalance caused by the ovaries (the organ that produces and releases eggs) creating excess male hormones. It affects people AFAB.
While PCOS is a common cause of hyperandrogenism, hyperandrogenism can have other causes and can affect people AMAB. Similarly, PCOS has other symptoms aside from hyperandrogenism, including ovarian cysts.
Hyperandrogenism can affect anyone — both children and adults. But it more commonly affects people assigned female at birth of reproductive age.
Hyperandrogenism is fairly common in people assigned female at birth of reproductive age. It affects about 5% to 10% of that population.
Hyperandrogenism less commonly affects children and adults assigned male at birth.
Hyperandrogenism has various symptoms depending on your sex and if you’ve been through puberty or not.
It’s important to note that you could have these symptoms of hyperandrogenism but have normal levels of androgens in your blood. This is because each of these symptoms has other possible causes. It’s also possible to have bloodwork tests show that you have high androgen levels while having mild or no physical symptoms.
If these symptoms develop rapidly and suddenly, it’s important to see your healthcare provider as soon as possible since the cause in this case is often an androgen-secreting tumor.
Symptoms of hyperandrogenism in pre-pubertal girls or children assigned female at birth (AFAB) include:
Symptoms of hyperandrogenism in pre-pubertal boys or children assigned male at birth (AMAB) include:
Symptoms of hyperandrogenism in women or adults AFAB include:
In men or adults AMAB, the effects of hyperandrogenism depend on if the source of excess hormones is from your adrenal glands or an outside source (such as anabolic steroid injections). Elevated levels of adrenal androgens have few noticeable physical effects in adults AMAB, but it can suppress the function of your testes and cause infertility.
In people assigned female at birth, the ovaries, adrenal glands and fat cells produce androgen hormones. In people assigned male at birth, the testicles and adrenal glands produce androgens.
There are also several other hormones that influence the production and release of androgens, such as luteinizing hormone (LH) and adrenocorticotrophic hormone (ACTH). Your pituitary gland releases both of these hormones.
If any one or more of these organs and/or hormones aren’t functioning properly, it can cause hyperandrogenism.
Hyperandrogenism has several possible causes, including:
Polycystic ovary syndrome (PCOS) is the most common cause of persistent hyperandrogenism beyond early puberty in adolescents and adults AFAB. Approximately 80% to 90% of people AFAB with hyperandrogenism have PCOS.
In PCOS, chronically elevated luteinizing hormone and insulin (hyperinsulinemia) levels lead to increased androgen production within your ovaries. In addition, hyperinsulinemia prevents your liver from producing sex hormone binding globulin (SHBG), which results in increased levels of free testosterone in your blood.
Congenital adrenal hyperplasia (CAH) consists of a group of genetic conditions affecting your adrenal glands.
In CAH, genetic mutations (changes) cause shortages of certain enzymes, such as 21-hydroxylase, that help your body produce needed hormones. For many people with CAH, the enzyme shortage causes their adrenal glands to overproduce other hormones, like testosterone.
Non-classical congenital adrenal hyperplasia, which involves a partial 21-hydroxylase deficiency, is the most common adrenal cause of hyperandrogenism. Approximately 2% of women or adults assigned female at birth with hyperandrogenism have late-onset nonclassical CAH.
Cushing disease is caused by a benign tumor located in your pituitary gland that releases too much ACTH (adrenocorticotropic hormone), which in turn increases cortisol.
Excess ACTH causes your adrenal glands to release excess androgens, which then causes hyperandrogenism.
Cushing syndrome has several other symptoms, including:
It’s important to see your healthcare provider as soon as possible if you have these symptoms.
Certain adrenal tumors and tumors in your ovaries or testicles can produce and release (secrete) androgens. This causes higher-than-normal androgen levels in your body. Hyperandrogenism caused by these kinds of tumors is often very severe and sudden.
Hyperandrogenism due to ovarian or adrenal tumors is rare. It’s responsible for only 0.2% of cases. But it’s important to see your provider right away if you have sudden symptoms of hyperandrogenism.
Certain medications can cause hyperandrogenism. The most common medications that cause it include:
If you’re a woman or person assigned female at birth and are concerned you may have hyperandrogenism, your healthcare provider will perform a physical exam to assess the possible physical symptoms of hyperandrogenism, such as excessive body hair growth. They’ll also ask you several questions about your medical history, including:
If your provider suspects hyperandrogenism, they’ll likely order blood tests to measure certain hormone levels. These tests can help with a diagnosis.
If you have signs or symptoms of hyperandrogenism, your provider may order certain blood tests, including:
Since each of the symptoms of hyperandrogenism has several other causes, your provider may order additional blood tests to rule out other possible causes of your symptoms.
Your provider may also order certain imaging tests to help diagnose the cause of hyperandrogenism, including:
Healthcare providers aim the medical treatment of hyperandrogenism at lowering ovarian or adrenal androgen production, reducing the free androgen levels and blocking the androgen action.
However, people with hyperandrogenism typically seek medical care for the treatment of its main symptoms, such as hirsutism, acne and irregular periods.
The medical treatment for hyperandrogenism depends on its cause. For example:
Antiandrogen drugs are also a common treatment for hyperandrogenism. They work by blocking the effects of androgens, such as testosterone.
Types of antiandrogen drugs include:
People with hyperandrogenism may seek treatments specifically for their symptoms, including:
When these symptoms are unresponsive to conventional therapy because of hormone imbalances, your provider may consider stronger antiandrogen medication.
Unfortunately, there’s no concrete way to prevent hyperandrogenism.
There’s no proven way to prevent PCOS, the most common cause of hyperandrogenism, but you can take small steps to reduce your symptoms. For example, eating nutritious foods, exercising regularly and managing your weight can help you reduce the effects of PCOS and hyperandrogenism.
Therapies for most causes of hyperandrogenism are lifelong. In some cases, people AFAB with PCOS-related hyperandrogenism no longer have PCOS after significant weight reduction. Most people, however, need continued therapy throughout their lifetime to minimize signs and symptoms of hyperandrogenism.
The signs and symptoms of hyperandrogenism can affect your self-esteem and mental health. It’s important to see a psychologist or therapist if you’re experiencing stress, anxiety and/or depression due to these symptoms.
If you’ve been diagnosed with hyperandrogenism and are taking medication for it, you’ll likely need to see your healthcare provider regularly to make sure your treatment is working.
If hyperandrogenism is affecting your mental health, it’s important to see a psychologist or therapist for help.
A note from Cleveland Clinic
Hyperandrogenism is a fairly common condition in women or people assigned female at birth. While its signs and symptoms may make you feel embarrassed or ashamed, know that you’re not alone and that the condition is treatable. Talk to your healthcare provider about treatment options and be sure to see a psychologist or therapist if it’s affecting your mental health.
Last reviewed by a Cleveland Clinic medical professional on 01/23/2023.
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