Hyperandrogenism: Symptoms, Causes, Treatment

What are the symptoms of hyperandrogenism?

Hyperandrogenism refers to the condition of excessive levels of androgens (male hormones) in the female body. The symptoms can vary depending on the underlying cause and individual factors, but common symptoms may include:

1. Hirsutism: Excessive hair growth in areas where men typically grow hair, such as the face (upper lip, chin), chest, back, and abdomen.
2. Acne: Severe or persistent acne, often resistant to typical treatments.
3. Male-pattern baldness: Thinning of hair on the scalp in a pattern similar to male baldness.
4. Irregular menstrual cycles: This can include absent periods (amenorrhea) or irregular periods (oligomenorrhea).
5. Oily skin: Skin that appears excessively oily or greasy.
6. Increased muscle mass: Some individuals may experience an increase in muscle mass.
7. Deepening of voice: In some cases, the voice may deepen.
8. Enlarged clitoris: Clitoromegaly, or enlargement of the clitoris, can occur in severe cases.

It’s important to note that hyperandrogenism can be a symptom of various underlying conditions such as polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia, ovarian or adrenal tumors, and other hormonal disorders. Diagnosis and management should be done under the guidance of a healthcare provider.

What are the causes of hyperandrogenism?

Hyperandrogenism, which involves excessive levels of androgens (male hormones) in females, can have various causes. These causes can be categorized into several groups:

1. Polycystic Ovary Syndrome (PCOS): PCOS is a common hormonal disorder characterized by enlarged ovaries with small cysts on the outer edges. It often leads to irregular menstrual cycles, infertility, and symptoms of hyperandrogenism such as hirsutism and acne.
2. Congenital Adrenal Hyperplasia (CAH): CAH is a group of inherited disorders caused by enzyme deficiencies in the adrenal glands. This results in inadequate cortisol production and an excess of androgens. CAH can manifest in infancy or later in life, depending on the specific enzyme deficiency.
3. Ovarian Tumors: Certain types of ovarian tumors, such as ovarian tumors that produce androgens (like androgen-secreting tumors), can lead to hyperandrogenism.
4. Adrenal Tumors: Adrenal tumors, particularly those that produce androgens (adrenal adenomas or carcinomas), can cause hyperandrogenism.
5. Cushing’s Syndrome: This condition occurs due to prolonged exposure to high levels of cortisol. It can result from adrenal gland tumors or prolonged use of corticosteroid medications, leading to symptoms including hyperandrogenism.
6. Exogenous Androgens: Sometimes, the use of anabolic steroids or other medications containing androgens can cause hyperandrogenism.
7. Insulin Resistance: Insulin resistance, which is often associated with conditions like obesity and diabetes mellitus type 2, can contribute to hyperandrogenism, particularly in the context of PCOS.
8. Idiopathic Hyperandrogenism: In some cases, the exact cause of hyperandrogenism may not be identified, leading to a diagnosis of idiopathic hyperandrogenism.

Diagnosis of hyperandrogenism typically involves a thorough medical history, physical examination, blood tests to measure hormone levels (including testosterone and DHEA-S), and sometimes imaging studies (such as ultrasound or MRI) to evaluate the ovaries or adrenal glands. Treatment depends on the underlying cause and may involve medications to regulate hormone levels, manage symptoms, or surgical intervention in cases of tumors.

How is the diagnosis of hyperandrogenism made?

The diagnosis of hyperandrogenism is typically made through a combination of physical examination, medical history, and laboratory tests. Here are the steps involved in making a diagnosis:

1. Physical Examination: A thorough physical examination is performed to assess for signs of androgen excess, such as:
   • Hirsutism (excessive hair growth on the face, chest, back, and buttocks)
   • Acne
   • Male pattern baldness
   • Clitoral enlargement
   • Deepening of the voice
2. Medical History: A detailed medical history is taken to identify potential causes of hyperandrogenism, such as:
   • Family history of hyperandrogenism or hirsutism
   • Use of androgenic medications or supplements
   • Menstrual irregularities or polycystic ovary syndrome (PCOS)
3. Laboratory Tests: The following laboratory tests may be ordered to confirm the diagnosis:
   • Androgen levels: Blood tests to measure the levels of testosterone, free testosterone, and dehydroepiandrosterone sulfate (DHEAS)
   • Hormone profiles: Blood tests to evaluate the levels of other hormones, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estrogen
   • TSH: Thyroid-stimulating hormone test to rule out hypothyroidism, which can also cause hyperandrogenism
   • Prolactin: Blood test to rule out hyperprolactinemia, which can also cause hyperandrogenism
4. Additional Tests: In some cases, additional tests may be performed to help confirm the diagnosis and rule out other conditions:
   • Insulin sensitivity test: To assess insulin resistance, which is common in PCOS and hyperandrogenism
   • Glucose tolerance test: To rule out diabetes mellitus, which can also cause hyperandrogenism
   • Ultrasonography: To evaluate ovulation and detect polycystic ovaries
5. Dermatological Examination: A dermatologist may perform a skin examination to assess for acne, seborrhea, and other skin conditions that may be related to hyperandrogenism.
6. Genetic Testing: In some cases, genetic testing may be performed to identify specific genetic mutations that can cause hyperandrogenism.

A diagnosis of hyperandrogenism is typically made based on the combination of physical examination findings, medical history, and laboratory test results. The diagnosis may also be confirmed by a dermatologist or endocrinologist.

What is the treatment for hyperandrogenism?

The treatment for hyperandrogenism typically involves a combination of lifestyle changes, medications, and other therapies. The specific treatment plan depends on the underlying cause of hyperandrogenism, the severity of symptoms, and the individual’s overall health. Here are some common treatment options:

1. Hormonal Regulation:
   • Birth control pills or hormonal contraceptives to regulate menstrual cycles and reduce androgen levels.
   • Anti-androgens, such as spironolactone or flutamide, to block the effects of testosterone.
   • GnRH agonists, such as leuprolide, to suppress pituitary gland production of gonadotropins, which can stimulate ovulation and reduce androgen levels.
2. Anti-Androgens:
   • Flutamide (Eulexin) to block the effects of dihydrotestosterone (DHT), a potent form of testosterone.
   • Spironolactone (Aldactone) to block the effects of aldosterone, a hormone that can contribute to hirsutism.
3. Hormonal Replacement Therapy:
   • Estrogen replacement therapy to alleviate symptoms of menopause or ovarian failure.
4. Medications for Acne:
   • Topical retinoids to reduce acne severity.
   • Antibiotics, such as doxycycline or minocycline, to treat acne caused by bacteria.
5. Surgical Options:
   • Electrocautery or laser hair removal to remove excessive hair.
   • Hormone-releasing implants or pellets to regulate hormone levels.
6. Lifestyle Changes:
   • Healthy diet and exercise to manage weight and insulin resistance.
   • Stress management techniques, such as yoga or meditation, to reduce stress levels.
7. Other Therapies:
   • Psychotherapy to address emotional and psychological distress related to hyperandrogenism.
   • Counseling to improve body image and self-esteem.

It’s essential to work with a healthcare provider to determine the best course of treatment for individual cases of hyperandrogenism. Treatment may involve a combination of these options, and it may take some trial and error to find the most effective approach.

Some popular medications used to treat hyperandrogenism include:

1. Spironolactone (Aldactone)
2. Flutamide (Eulexin)
3. Cyproterone acetate (Androcur)
4. Diane-35 (a combination of ethinyl estradiol and cyproterone acetate)
5. Yasmin (a combination of ethinyl estradiol and drospirenone)

It’s important to note that some medications may have potential side effects, and it’s crucial to discuss these risks with a healthcare provider before starting treatment.