Other causes include adrenal hyperplasia, hirsutism, insulin resistance, hyperprolactinemia, Cushing's disease, certain types of cancers, and certain medications. Diagnosis often involves blood tests for testosterone, 17-hydroxyprogesterone, and prolactin, as well as a pelvic ultrasound. Treatment depends on the underlying cause.
| Hyperandrogenism | |
|---|---|
| Symptoms | Acne, hair loss on scalp, increased body or facial hair, infrequent or absent menstruation |
| Causes | Polycystic ovary syndrome, adrenal hyperplasia, Cushing's disease, cancer |
| Diagnostic method | Blood tests, ultrasound |
| Treatment | Birth control pills, cyproterone acetate, spironolactone |
What are the most common conditions associated with hyperandrogenism?
What are the causes of hyperandrogenism? The main causes of this disorder are: Polycystic ovary syndrome (PCOS) Malfunction of the adrenal gland Diseases of the pituitary gland – Cushing syndrome or Acromegaly Obesity and metabolic syndrome Certain medications – including anabolic steroids How is hyperandrogenism diagnosed?
What is the treatment for adrenal hyperandrogenism?
Causes of Androgen Excess Several disorders give rise to androgen excess. They include unusual causes such as iatrogenic or drug-induced androgen excess, congenital genital ambiguity (e.g., excessive in utero androgen formation in 46,XX disorders of sex development), and conditions unique to pregnancy (e.g., luteoma of pregnancy, hyperreactio luteinalis).
What is hyperandrogenism (androgen excess)?
For hyperandrogenism caused by late-onset congenital adrenal hyperplasia, treatment is primarily focused of providing the patient with glucocorticoids to combat the low cortisol production. When helping the patient to conceive, medication can be used to induce ovulation.
What is the relationship between hyperandrogenism and Cushing's syndrome?
Some signs and symptoms of postmenopausal hyperandrogenism can be normal and attributed to the natural aging process. However, the causes of androgen excess in this group include both nontumorous and tumorous causes. Treatment of androgen excess may improve both quality of life and long-term metabolic outcomes. Keywords:
What are the causes of hyperandrogenism?
What are the causes of hyperandrogenism?Polycystic ovary syndrome (PCOS)Malfunction of the adrenal gland.Diseases of the pituitary gland – Cushing syndrome or Acromegaly.Obesity and metabolic syndrome.Certain medications – including anabolic steroids.
How do you fix hyperandrogenism?
Hyperandrogenism may be treated with birth control, anti-androgen drugs, insulin reducing drugs, hair removal methods, and acne medications.Feb 18, 2022
What causes excess androgens in females?
Causes. In healthy women, the ovaries and adrenal glands produce about 40% to 50% of the body's testosterone. Tumors of the ovaries and polycystic ovary syndrome (PCOS) can both cause too much androgen production. Cushing disease is a problem with the pituitary gland that leads to excess amounts of corticosteroids.Jun 8, 2020
What is the most common cause of androgen excess?
A specific underlying cause can be identified in most patients with androgen excess.Polycystic ovary syndrome (PCOS) Approximately 80-90% of women with excess androgens have PCOS. ... Ovarian hyperthecosis. ... Congenital adrenal hyperplasia. ... Cushing syndrome. ... Androgen secreting tumors. ... Pregnancy.Feb 7, 2022
How is hyperandrogenism treated in PCOS?
In adolescents with PCOS, hyperandrogenism is central to the presentation; hormonal contraceptives and metformin are treatment options in this population. Postmenopausal women do not have a consistent PCOS phenotype.Sep 19, 2019
How can a woman reduce androgens?
Foods to Lower AndrogensStudies have shown drinking tea (hot or iced) may help improve PCOS symptoms. Spearmint tea, for example, has been shown to have anti-androgen effects in PCOS and can reduce hirsutism.Marjoram herb is reputed for its ability to restore hormonal balance and to regulate the menstrual cycle.
How can I naturally reduce androgens?
Here are 8 evidence-based ways to increase testosterone levels naturally.Exercise and Lift Weights. ... Eat Protein, Fat and Carbs. ... Minimize Stress and Cortisol Levels. ... Get Some Sun or Take a Vitamin D Supplement. ... Take Vitamin and Mineral Supplements. ... Get Plenty of Restful, High-Quality Sleep.More items...
What is anti androgen medication?
antiandrogen, any drug that blocks the effects of androgens (male hormones) on the body. The antiandrogens include drugs that inhibit testosterone synthesis, block androgen receptors (known as androgen-receptor antagonists), or inhibit the conversion of testosterone to its more active form, dihydrotestosterone.
How do you know if you have hyperandrogenism?
Hyperandrogenism is a medical condition characterized by high levels of androgens. It is more common in women than men. Symptoms of hyperandrogenism may include acne, seborrhea (inflamed skin), hair loss on the scalp, increased body or facial hair, and infrequent or absent menstruation.
Why does PCOS cause hyperandrogenism?
Hyperandrogenism is the defining feature of women with PCOS. It is caused by the disruption of normal ovarian or adrenal function resulting in the production of excess androgens. The first impact of androgen excess in PCOS is impaired folliculogenesis.Nov 20, 2019
What organ in the female body is mainly affected by androgen excess?
Androgen excess is the most common endocrine disorder in women of reproductive age. Androgens are produced primarily by the adrenal glands and the ovaries.Feb 7, 2022
What effect do androgens have on females?
Androgens are hormones that contribute to growth and reproduction in both men and women. Androgens are usually thought of as male hormones, but the female body naturally produces a small amount of androgens too.
How to treat hyperandrogenism?
Hyperandrogenism is treated with the use of hormone therapy. Treatment for patients that suffer from acne includes topical creams, oral antibiotics such as tetracycline, antiandrogens (hormone therapy, including birth control pill) and oral isotretinoin.
What are the symptoms of high testosterone?
High levels of testosterone in the female body can cause the following male characteristics: 1 Oily skin (seborrhoea) 2 Acne 3 Thick hair growth (hirsutism) - on the face particularly the beard and moustache area, limbs, underarm and pubic area 4 Deep voice 5 Male pattern balding 6 Irregular menstruation 7 Increased muscle mass and smaller breast size 8 Infertility 9 Obesity
What is PCOS in medical terms?
Polycystic ovary syndrome (PCOS) Malfunction of the adrenal gland. Diseases of the pituitary gland – Cushing syndrome or Acromegaly. Obesity and metabolic syndrome. Certain medications – including anabolic steroids.
What causes hyperandrogenism in the adrenal gland?
In the adrenal, it is caused by an enzymatic defect in congenital adrenal hyperplasia, usually partial 21-hydroxylase deficiency and rarely Cushing's disease and neoplasia. The clinical response to excess androgens varies and is genetically and race dependent. Caucasians are most sensitive and Asians are least sensitive. Oily skin, acne, and excess coarse facial, chest/breast, back, and genital area hair may be found. In more severe cases, signs of virilization (clitoromegaly and voice changes) may be present. The ovary frequently contains small cysts and there is thecal thickening and stromal hypertrophy. The endometrial lining may cause hyperplasia. Menstrual dysfunction ranges from minimal to anovulation and amenorrhea, frequently leading to infertility.
What is the most common gynecological disorder?
Hyperandrogenism caused by overproduction of androgens or decreased androgen metabolism is responsible for the most prevalent gynecological disorder, polycystic ovary syndrome (PCOS). From: Encyclopedia of Reproduction (Second Edition), 2018. Download as PDF. About this page.
What percentage of women have PCOs?
According to Rosenfield, women with PCOS account for approximately 95% of cases of hyperandrogenism in the general population.
Is hyperandrogenism biochemical or biochemical?
Hyperandrogenism may be defined on the basis of cutaneous signs (see Box 15-8) but is best established biochemically if a reliable testosterone assay is available because hirsutism, particularly mild hirsutism, is an unreliable surrogate for hyperandrogenemia. The problematic nature of many androgen assays is discussed in the “Differential Diagnosis” section.
Does Glycyrrhiza glabra affect testosterone?
Hyperandrogenism is characteristic of PCOS, so antiandrogen botanicals such as Glycyrrhiza glabra are indicated. G. glabra affects androgen metabolism by blocking the effects of 17β-hydroxysteroid dehydrogenase and C17,20 lyase while stimulating the effects of aromatase, reducing serum testosterone , making it useful as an adjuvant therapy of hirsutism associated with PCOS.193 Glycyrrhizic acid (a triterpenoid saponin glycoside, a bioactive component in G. glabra) possesses protective activity against AGE-induced endothelial dysfunction, including antiapoptosis, anti-inflammation, and antioxidant stress, via inhibiting the RAGE/nuclear factor (NF)-kB pathway, and may be potentially useful in the management of PCOS via its anti-inflammatory and antioxidant capacity.194
Is hyperandrogenemia a disease?
Functional hyperandrogenism or chronic unexplained hyperandrogenemia is a relatively frequent problem and it is not a disease if abnormal situations, such as androgen-producing tumors or other well- defined pathologies, have already been excluded. It may be expressed by hirsutism, acne, male pattern baldness, anovulation/oligomenorrhea, or central obesity. It is more pronounced in certain geographic areas and among certain ethnic groups (Mediterranean area).
Does hyperandrogenism affect fertility?
[ 97] In addition, the reduced frequency of ovulation is associated with decreased opportunities for conception. Hyperandrogenism probably has an impact on fertility in addition to anovulation. Many studies suggest a decreased conception rate in spite of induced ovulation, and some suggest an increased risk for spontaneous miscarriage in hyperandrogenic women. [ 3, 98] The mechanisms for this androgen action remain to be determined.
What is the treatment for hyperandrogenism?
In late-onset CAH, glucocorticoids can be used. Estrogen-based oral contraceptives are used to treat both CAH and polycystic ovary syndrome. Hirsutism and acne both respond well to these hormonal treatments, but alopecia (i. e. hair loss) requires other methods.
What is hyperandrogenic women?
Hyperandrogenic women have ovulatory dysfunction of various seriousness. It can be clinically expressed as menstrual dysfunction. For example, the patient can suffer from oligomenorrhea (i. e. infrequent menstrual periods), episodes of amenorrhea (i. e. absence of menstruation), pelvic pain, menorrhagia (i. e. excessively heavy menstrual flow), disturbance of fertility, and others. In pregnancy, spontaneous miscarriages are increased in their incidence. Pregnancy complications such as gestational diabetes (a condition in which, during pregnancy, a woman otherwise without diabetes develops high blood sugar levels) can occur.
What is laparotomic drilling for ovarian cancer?
In polycystic ovary syndrome, laparotomic drilling of the ovarian cortex is sometimes used to remove the dysfunctional tissue. However, the results are only temporary and the benefits tend to be overshadowed by the possible postoperative complications.
How to help polycystic ovary syndrome?
The core of therapy lies within the conventional medicine. Healthy lifestyle including exercise, rational diet, and maintaining optimal weight can help along. In women with polycystic ovary syndrome who are overweight, weight loss has been proven to improve the chances of conceiving as well as to minimize complications during pregnancy.
Is hyperandrogen idiopathic?
Numerous possible causes to hyperandrogenism have been described. Moreover, as the disease can be idiopathic (i. e. the cause is unknown), it is clear that more pathological processes elevating androgen levels are yet to be described. The risk factors are not known and vary among individuals. This all results into the fact that there is no sure method of prevention. What can help decrease the risk of long-term problems are medical check-ups, especially if one has a family history of the condition, irregular periods, or diabetes. Moreover, patients benefit from watching their weight and diet (especially in obese women, since healthy diet and continued exercise leads to an improved menstrual cycle, decreased insulin levels and androgen concentrations).
Abstract
The differential diagnosis of the hyperandrogenic patient includes idiopathic hirsutism, polycystic ovary syndrome (PCOS), the hyperandrogenic insulin-resistant acanthosis nigricans (HAIRAN) syndrome, 21-hydroxylase-deficient non-classic congenital adrenal hyperplasia or classic congenital adrenal hyperplasia, and androgen-secreting neoplasm.
About this chapter
Stracquadanio M. (2020) Causes of Hyperandrogenism. In: Managing Women’s Hyperandrogenism. Springer, Cham. https://doi.org/10.1007/978-3-030-29223-2_2
What causes hyperandrogenism?
Other less common potential causes of hyperandrogenism include nonclassic congenital adrenal hyperplasia, androgen-secreting tumors, hypothyroidism, Cushing disease, and severe hyperprolactinemia. The diagnosis of hyperandrogenism can be based on clinical symptoms or measurement of serum androgens.
What are the symptoms of androgen excess?
Although androgen excess can manifest in many ways, the most common and recognizable symptoms are hirsutism and acne. (Alopecia also may be a symptom.) Hirsutism affects 5–10% of reproductive-aged females and is defined as excessive terminal hair growth in a distribution typically seen in adult men (face, sternum, lower abdomen, back, and thighs) 1. Acne vulgaris is a multifactorial skin condition of varying severity that affects as many as 90% of all adolescents 2. It is critical that the commonality of these conditions does not lead obstetrician–gynecologists and other health care providers to dismiss them as trivial. Reports of hirsutism and acne should be taken seriously because of their possible association with medical disorders, their substantial effect on self-esteem and quality of life, and the potential for psychosocial morbidity 3. In patients with symptoms of androgen excess, the differential diagnosis should include physiologic hyperandrogenism of puberty, idiopathic hyperandrogenism, and PCOS. Other less common potential causes of hyperandrogenism include nonclassic congenital adrenal hyperplasia, androgen-secreting tumors, hypothyroidism, Cushing disease, and severe hyperprolactinemia.
How to treat acne in adolescents?
A variety of therapies can be used to treat acne in adolescents Table 1. As with hirsutism, multimodal therapy may be more effective, and response to therapy may take several months. Working with a dermatologist can be beneficial for patients with moderate-to-severe acne or acne refractory to initial medical therapy. Referral to a dermatologist should be made for complex cases. Acne treatment algorithms often show topical therapy as a first-line approach. Many patients will have tried multiple over-the-counter topical regimens before coming to their obstetrician–gynecologists. However, even in patients who have not used other medications, hormonal therapy, such as a combination OCP, can be considered an acceptable first-line treatment for patients who desire this method.
Which enzyme converts testosterone to dihydrotestosterone?
The pilosebaceous unit expresses 5α-reductase, which converts testosterone to the highly potent dihydrotestosterone. Varying expression of enzyme activity within the pilosebaceous unit leads to a lack of clear correlation between serum androgens and the presence or severity of acne and hirsutism.
Is spironolactone an aldosterone antagonist?
Spironolactone is approved for the treatment of hirsutism and works as a competitive inhibitor of the androgen receptor and 5α-reductase inhibitor. It also is an aldosterone antagonist. Typical doses for the treatment of hirsutism range from 50 to 200 mg daily 19.
What are the signs of insulin resistance?
It also is useful to assess for signs of insulin resistance, such as hypertension, obesity, centripetal fat distribution, skin tags, and acanthosis nigricans.
Can metformin be used for PCOS?
Metformin is an insulin sensitizer that may reduce serum androgens and can be used in the setting of insulin resistance in adolescents with PCOS 11 21. Among adolescents randomized to metformin or spironolactone, both medications improved hirsutism, but spironolactone showed a greater benefit 22.
Overview
Treatment
There is no definitive treatment for hyperandrogenism as it varies with the underlying condition that causes it. As a hormonal symptom of PCOS, menopause, and other endocrine conditions, it is primarily treated as a symptom of these conditions. Drugs may be considered only in women who do not plan on becoming pregnant in the near future. Some effective drugs for facial hirsutism includes eflornithine, which may cause birth defects in pregnant women. Retinoids and antibioticscan …
Signs and symptoms
Hyperandrogenism affects 5–10% of women of reproductive age. Hyperandrogenism can affect both men and women but is more noticeable in women since elevated levels of androgens in women may facilitate virilization. Because hyperandrogenism is characterized by elevated male sex hormone levels, symptoms of hyperandrogenism in men are often negligible. Hyperandr…
Causes
While hyperandrogenism in women can be caused by external factors, it can also appear spontaneously.
Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by an excess of androgens produced by the ovaries. It is estimated that approximately 90% of women with PCOS demonstrate hypersecretion of these hormones. Th…
Diagnosis
Diagnosing hyperandrogenism can be complex due to the wide variety and severity of signs and symptoms that may present. It is most often diagnosed by checking for signs of hirsutism according to a standardized method that scores the range of excess hair growth.
Girls may show symptoms of hyperandrogenism early in life, but physicians become more concerned when the patient is in her late teens or older.
Prevention
Since risk factors are not known and vary among individuals with hyperandrogenism, there is no sure method to prevent the condition. Accordingly, more long-term studies are needed to find a cause of the condition before a sufficient method of prevention can be established.
Despite this, there are a few things that can help avoid long-term medical issues related to hyperandrogenism and PCOS. Getting checked by a medical professional for hyperandrogenism …
Society and culture
Because androgen excess is manifested in noticeable physical features (such as hirsutism), social stigma may be associated with it.
Current evidence-based studies show that unusually high levels of circulating testosterone are associated with increased athletic performance in women, unless they lack androgen sensitivity. However, controversy has emerged in the form of the claim that testosterone is not unlike any ot…
See also
• Hypoandrogenism
• Hypergonadism
• Hypergonadotropic hypergonadism
• Hypogonadism
• Hyperestrogenism