Are you also concerned about an increase in male hormones in the body? Let's talk about hyperandrogenism!

Are you worried about some changes in your body? Perhaps the reason is an increase in the amount of androgen, a type of male hormone, in the body. This condition is medically called hyperandrogenism . Don't worry, we will talk about this simply, in a way that you can understand.

What exactly is hyperandrogenism?

Simply put, hyperandrogenism means that your body has too many androgens, a type of sex hormone. Androgens are important for puberty, reproductive health, and body growth.

Now look, hormones are chemicals in our bodies. They're like messengers. They travel through the blood and tell our organs, muscles, and other tissues what to do and when to do it.

Androgens are produced in everyone's body. But men produce the most. Women produce about one-twelfth of the amount in a man's body. Testosterone is the main one of these androgens.

Androgens are produced by the testicles in men and the ovaries in women. These hormones are also produced by the adrenal glands located above our kidneys. They also help convert weak androgens into stronger ones in places like fat tissue and skin.

The symptoms of this condition, called hyperandrogenism, can vary depending on your age and gender. There are several possible causes, and there are treatments for it.

Are Hyperandrogenism and PCOS the same thing?

Many people think that hyperandrogenism and polycystic ovary syndrome (PCOS) are the same disease. Although there is a close relationship between the two, they are not the same.

Hyperandrogenism is a key feature of PCOS. PCOS is a hormonal imbalance caused by the ovaries producing too much male hormones. It affects women.

So, although PCOS is a common cause of hyperandrogenism, there can be other causes of hyperandrogenism. Similarly, PCOS has other symptoms, such as ovarian cysts, in addition to the symptoms of hyperandrogenism.

Who is most affected by this condition? How common is it?

Hyperandrogenism can affect anyone - young children, adults, everyone. However, it is most common in women of childbearing age .

This condition affects between 5% and 10% of women of reproductive age, meaning it's not as rare as you might think.

This condition is less likely to affect boys and adult men.

What are the symptoms of this?

The symptoms of hyperandrogenism vary depending on your gender and whether you have gone through puberty.

But here's an important thing to remember. Even if you have these symptoms, your blood androgen levels may be normal. This is because each of these symptoms can have other causes. Also, even if blood tests show that your androgen levels are high, you may not have any major symptoms.

The most important thing is that if these symptoms appear suddenly and rapidly, you should definitely see a doctor as soon as possible, because in such cases, the cause may be an androgen-secreting tumor.

Now let's see how this affects different people.

For girls (before puberty)

• Enlarged clitoris .
• Acne and oily skin.
• Unwanted growth of body hair (hirsutism) . This means that the "light brown hair" is replaced by coarse, coarse hair on areas such as the upper lip, chin, chest, stomach, and back.

For male children (before puberty)

• Enlarged penis .
• Early or excessive hair growth in the private area and armpits.
• Deepening of the voice.

For older women

• Acne and oily skin.
• Unwanted growth of body hair follicles ( hirsutism) .
• Irregular monthly menstrual cycle.
• Difficulty having children (infertility) .
• Male pattern hair loss ( androgenic alopecia) .

For adult men

How this affects adult men depends on whether the extra hormones come from the adrenal glands or from something taken externally (such as anabolic steroid injections). If the androgens from the adrenal glands increase, adult men may not notice any major physical changes. However, it can reduce the function of the testicles and make it difficult to have children.

Why is this happening? What are the reasons?

Androgen hormones are produced by the ovaries, adrenal glands, and fat cells in women, and by the testicles and adrenal glands in men.

There are several other hormones that affect the production and release of these androgens. For example , luteinizing hormone (LH) and adrenocorticotrophic hormone (ACTH) . Both of these hormones are released by the pituitary gland.

If one or more of these organs, or one of these hormones, does not function properly, hyperandrogenism can occur.

There are several main reasons for this:

• Polycystic ovary syndrome (PCOS) - This is the most common cause.
• Congenital Adrenal Hyperplasia (CAH) .
• Cushing's disease .
• Androgen-secreting tumors.
• Some medications.

Now let's look at each of these reasons in a little more detail.

Polycystic ovary syndrome (PCOS)

Among young and older women, PCOS is the most common cause of persistent hyperandrogenism after puberty. Between 80% and 90% of women with hyperandrogenism also have PCOS .

In PCOS, the ovaries produce more androgens due to persistently high levels of LH and insulin (hyperinsulinemia). In addition, the increased insulin levels also inhibit the liver from producing a protein called Sex Hormone Binding Globulin (SHBG) . This increases the level of free testosterone in the blood.

Congenital adrenal hyperplasia `(CAH)`

Congenital adrenal hyperplasia (CAH) is a group of genetic conditions that affect the adrenal glands.

In CAH, genetic mutations cause a deficiency in an enzyme called 21-hydroxylase , which helps the body make hormones. In many people with CAH, this enzyme deficiency causes the adrenal glands to produce more of other hormones, such as testosterone.

The most common cause of hyperandrogenism in women with adrenal hyperplasia is non-classical congenital adrenal hyperplasia . This is a condition in which the enzyme 21-hydroxylase is partially deficient. This condition affects about 2% of women with hyperandrogenism.

Cushing's disease

Cushing's disease is a type of condition called Cushing syndrome . Cushing syndrome is a rare condition that occurs when the body has too much cortisol (also a hormone).

Cushing's disease is caused by a non-cancerous tumor in the pituitary gland. This tumor secretes excess ACTH (adrenocorticotropic hormone), which increases cortisol levels.

Excess ACTH causes the adrenal glands to release excess androgens, which is what causes hyperandrogenism.

Cushing syndrome has other symptoms:

• Purple stretch marks on the abdomen.
• Rapid weight gain in the face, stomach, and neck area.
• High blood pressure.

If you have symptoms like these, it is very important to see a doctor as soon as possible.

Androgen-secreting tumors

Some adrenal gland tumors, or tumors in the ovaries or testicles, can produce and secrete androgens. This causes the body's androgen levels to be higher than normal. The condition of hyperandrogenism caused by these tumors is often very severe and comes on suddenly .

Hyperandrogenism, caused by ovarian or adrenal tumors, is rare. It affects only about 0.2% of people. However, if you suddenly develop symptoms of hyperandrogenism, see a doctor immediately.

Some medications

Some medications can also cause hyperandrogenism. The main medications that cause this are:

• Anabolic-androgenic steroids (these are synthetic forms of testosterone, misused by some athletes to enhance performance).
• Synthetic progestins (these are medications that cause changes in the uterus and are used for various things).
• Antiepileptic drugs ( medicines to prevent seizures ).

How do you find this? (Diagnosis)

If you're a woman and you suspect you have hyperandrogenism, your doctor will do a physical exam and look for symptoms like unwanted hair growth. They will also ask you a few questions about your medical history:

• The age at which breasts begin to develop.
• The age at which hair begins to appear in the private area.
• Age at first menstruation.
• Do you remove hair (shave, have you had laser hair removal)?
• Have you ever used anabolic steroids or testosterone without a doctor's prescription?
• Things like how often your period comes, how many days it lasts, and how much blood you bleed.

If your doctor suspects that you have hyperandrogenism, they will order blood tests to check certain hormone levels. These tests can help diagnose the condition.

What kind of tests are done?

If you have symptoms of hyperandrogenism, your doctor may order blood tests like these:

• Total testosterone : This measures the total amount of testosterone in your blood. This level may be slightly elevated in women with PCOS. If it is very high, it could be a sign of a tumor in the ovaries or testicles.
• Free testosterone : This testosterone is not bound to any protein. This is a small amount of total testosterone. This level may also be increased in women with PCOS.
• Androstenedione : This is a steroid hormone that has little androgenic effect on the body. However, it mainly acts as an intermediate step in the production of testosterone and estrogen in the body. If its levels are high, PCOS may be present.
• Dehydroepiandrosterone sulfate (DHEAS) : DHEAS is a sex hormone produced by the adrenal glands. Therefore, it is a good indicator of adrenal androgen production. It is normal for women with PCOS to have slightly elevated DHEAS levels. If it is very high, it could be a sign of an adrenal tumor.
• 17-hydroxyprogesterone : Measuring the level of 17-hydroxyprogesterone in the blood is a basic test to check for the presence of non-classic congenital adrenal hyperplasia, a condition that is one cause of hyperandrogenism.

Since there can be other causes for the symptoms of hyperandrogenism, your doctor will order other blood tests to rule out those causes as well.

Additionally, imaging tests such as these may be performed to determine the cause of hyperandrogenism:

• A pelvic ultrasound to check for ovarian cysts (another symptom of PCOS) or other lumps.
• To check for adrenal gland tumors , CT scan (Computed tomography - CT) or MRI scan (Magnetic resonance imaging - MRI) tests are performed.

Doctors aim to reduce androgen production from the ovaries or adrenal glands, reduce free androgen levels, and block androgen action.

However, people with hyperandrogenism usually seek medical advice to treat the main symptoms, such as unwanted hair growth, acne, and irregular menstruation.

What are the treatments for this?

Treatment for hyperandrogenism depends on the cause. For example:

• Adrenal hyperandrogenism can be controlled with low-dose corticosteroids .
• If there are tumors in the ovaries, testicles, or adrenal glands, they may need to be surgically removed. In perimenopausal or menopausal women with severe hyperandrogenism, an oophorectomy (surgical removal of one or both ovaries) may also be necessary.
• If hyperandrogenism is caused by a medication you are taking, your doctor will either recommend stopping the medication or switching to a different medication.

Antiandrogen medications are also a common treatment for hyperandrogenism. They block the effects of androgens, such as testosterone.

There are several types of antiandrogen drugs:

• Oral contraceptives/birth control pills containing ethinyl estradiol (estrogen) and antiandrogenic progesterone: Examples include pills containing cyproterone acetate (e.g. Diane®-35), drospirenone (e.g. Yasmin®, Yaz®) or dienogest (e.g. Valette®). These can treat acne, unwanted hair growth and irregular periods.
• Spironolactone (Aldactone®) : This antiandrogen treats acne and unwanted hair growth caused by hormones.
• Cyproterone : This medication helps treat PCOS, lower testosterone levels, and reduce the production of oil that causes acne.

Treatment of symptoms

People with hyperandrogenism may seek treatment specifically for their symptoms:

• Acne : Treatments for acne include topical medications, oral antibiotics such as tetracycline , antiandrogens (including hormone therapy, birth control pills), and isotretinoin pills.
• Hirsutism (unwanted hair growth) : Many women with hirsutism resort to methods such as waxing, shaving, and laser hair removal. They may also take birth control pills.
• Irregular periods : Women can use hormonal birth control methods to regulate their menstrual cycles.

When these symptoms do not respond to standard treatments due to hormonal imbalance, your doctor may consider more powerful antiandrogen medications.

Can't this be prevented?

Unfortunately, there is no clear way to prevent hyperandrogenism.

There is 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 a nutritious diet, getting regular exercise, and controlling your weight can help reduce the effects of PCOS and hyperandrogenism.

What will the future hold? (Prognosis)

Many conditions that cause hyperandrogenism require lifelong treatment. Sometimes, women with hyperandrogenism due to PCOS will lose significant weight and their PCOS will go away. However, most people will need lifelong treatment to reduce the symptoms of hyperandrogenism.

Hyperandrogenism symptoms can affect your self-esteem and mental health. If these symptoms are causing you to feel stressed, anxious, and/or depressed, it is important to seek help from a psychiatrist or counselor.

When should I see a doctor?

If you are diagnosed with hyperandrogenism and are taking medication for it, you will need to see a doctor regularly to make sure your treatment is working properly.

If hyperandrogenism is affecting your mental health, it is essential to see a psychiatrist or counselor for help.

Finally, take-home message:

Hyperandrogenism is a relatively common condition among women. Its symptoms can make you feel embarrassed and uncomfortable. But remember, you are not alone, and this condition can be treated. Talk to your doctor about treatment options. Also, if it is affecting your mental health, be sure to see a psychiatrist or counselor. Taking care of your health is the most important thing.

` Hyperandrogenism, Androgen, Testosterone, PCOS, Hirsutism, Acne, Hormonal Imbalance, Women's Health, Hormonal Imbalance