What is Hyperandrogenism?

Hyperandrogenism, also known as androgen excess, is an endocrine (hormonal gland) disorder that is characterized by elevated levels of male hormones (e.g., testosterone). Hyperandrogenism can affect females or males; however, symptoms are more noticeable in female patients. Hyperandrogenism can lead to acne, oily skin, balding, and signs of masculinization, such as facial hair or a deep voice. (13)(32) 

Continue reading below to learn more about the effects of androgen excess in females and strategies to manage the signs and symptoms of hyperandrogenism. 

What are androgens?

Androgens are a group of hormones that regulate the development and maintenance of male characteristics. Androgens may be known as “male hormones,” but don’t be fooled by the name. Both men and women produce androgens, but in differing amounts. Androgens, such as testosterone, are present in much higher levels in males compared to females, and they play an important role in the development of male traits and reproductive activity. (8)

Other androgens include dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S) and androstenediol. (10) In females, most androgens are converted into estrogen, a female sex hormone. (3) 

Did you know? Females produce about one-twelfth as much androgen as men. (3)

Effects of androgens in females

In women, androgens play an important role in the hormonal surge that commences puberty, leading to hair growth in the pubic and underarm areas. (14) In adult females, androgens are necessary for estrogen production and have been shown to play a key role in the prevention of bone loss as well as sexual desire and satisfaction. (7)(9)

Androgens are also thought to regulate the function of many organs, including the kidneys, liver, muscles, and the reproductive tract. (24)(28)(30)(33) Androgens may also play a role in regulating body composition, the amount and distribution of body fat and muscle. (29)

Symptoms of hyperandrogenism 

Androgen excess disorders can often go undiagnosed, even though the symptoms may be treated. The signs and symptoms of hyperandrogenism include: 

• Abdominal obesity
• Acanthosis nigricans (rough, darkly pigmented areas on the skin)
• Alopecia (thinning/loss of hair on the head)
• Deep, hoarse voice 
• Enlargement of the clitoris
• High blood pressure (hypertension)
• Hirsutism (excess body or facial hair)
• Insulin resistance (cells stop responding to the hormone insulin)
• Irregular or absent menstrual cycles
• Low HDL cholesterol (“good cholesterol”) and high LDL cholesterol (“bad cholesterol”)
• Persistent acne and/or oily skin
• Weight gain (25) 

Consult with your healthcare provider if you are concerned about hyperandrogenism.

Causes of hyperandrogenism

Androgen excess in females can arise from a variety of medical conditions that affect the endocrine glands such as adrenal glands, ovaries, or pituitary glands. (15)

1. Acromegaly

The pituitary gland is a tiny hormone-secreting gland attached to the brain. It produces hormones and controls other endocrine glands and bodily functions, including growth and reproduction. (19) Acromegaly is a rare, progressive disorder that occurs when the pituitary gland produces too much growth hormone (GH), leading to the excess growth of body tissues over time. (27) Acromegaly occurs in adults and is typically triggered by a noncancerous (benign) tumor of the pituitary gland which increases the release of GH. (21)

The relationship between acromegaly and hyperandrogenism is not well understood. High levels of GH may impair sex hormone binding globulin (SHBG), a protein produced by the liver that attaches to sex hormones ciculating within the body. Low levels of SHBG allows more testosterone to be freely available, potentially increasing the amount of testosterone getting to the body’s tissues. (15)(20)

2. Congenital adrenal hyperplasia

Congenital adrenal hyperplasia (CAH) is an inherited genetic disease that results in abnormal functioning of the adrenal glands. The adrenal glands are two small organs located above the kidneys. (22) The adrenal glands produce a variety of hormones, such as adrenaline and testosterone. Individuals with CAH experience impaired production and regulation of certain hormones, potentially leading to adrenal androgen excess. (23)

3. Cushing’s syndrome

Cushing’s syndrome is an adrenal gland disorder that occurs when the body is exposed to high levels of cortisol (stress hormone) over an extended period of time. This can happen for a number of reasons, including long-term steroid use or excess cortisol production by the body. (16) Since Cushing’s syndrome affects the adrenal glands, serum androgens tend to be elevated or diminished depending on the root cause of Cushing’s syndrome. (4)

4. Polycystic ovary syndrome 

The ovaries are a pair of female glands that are a part of the female reproductive system. Eggs are formed in the ovaries, as well as the female hormones estrogen and progesterone. (18) Polycystic ovary syndrome (PCOS) is a condition that disrupts normal ovarian function and affects hormone levels. It involves infrequent, irregular, or prolonged menstrual periods and often excess androgen levels. (5)(26) 

Management of hyperandrogenism

Managing hyperandrogenism can be complicated as symptoms vary from person to person. Many individuals with hyperandrogenism benefit from making healthy lifestyle changes. Weight management and blood sugar control can be helpful ways to address symptoms of androgen excess. (17) Modest weight loss in individuals with obesity can help to decrease androgen levels and increase SHBG. (6) For some, hyperandrogenism treatment may also involve pharmacological agents or cosmetic interventions.

Acne treatments

A variety of therapies can be used to treat acne. Working with a dermatologist can be beneficial for those with moderate-to-severe acne that doesn’t respond to over-the-counter acne treatments. Consult with your healthcare practitioner to learn more about the best acne treatment options for you. (1) 

Birth control

For women who are not trying to get pregnant, oral contraceptives (birth control pills) can be used to reduce androgens and help address symptoms. (11) 

Combined estrogen-progesterone birth control is usually tried first. This type of birth control typically uses estrogen in the form of ethinyl estradiol. Taking estrogen in this form may lead to an increase in SBGH, which reduces free testosterone. (31) 

Hair removal 

Physical methods of hair removal such as bleaching, electrolysis, laser therapy, shaving, and waxing can be used safely and effectively. Of these methods, only electrolysis and laser therapy can permanently stop hair growth. (12) 

Medications 

Anti-androgen medications block the production of androgens which may help lessen certain symptoms of androgen excess including acne, oily skin, and unwanted hair growth. (12) 

Other medications that are not considered anti-androgenic may also be used to alleviate some symptoms. Insulin resistance is one of the main triggers of hyperandrogenism in females with polycystic ovary syndrome. Metformin, a pharmaceutical agent often used to address type 2 diabetes, helps improve the way the body handles insulin. Normalizing insulin levels may reduce serum androgens and decrease unwanted hair growth and acne. (17)

The bottom line

Androgens are a group of hormones that regulate the development and maintenance of male sex characteristics. They are present in both males and females, although males produce much higher amounts. Hyperandrogenism, or androgen excess, may lead to balding, exaggerated masculine characteristics, severe acne, or unwanted hair growth. Management of hyperandrogenism usually focuses on addressing problematic symptoms. Consult with your integrative healthcare practitioner to learn more about hyperandrogenism and its treatment options.