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)
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)
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.
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)
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)
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)
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.
- ACOG Committee. (2019). Screening and management of the hyperandrogenic adolescent. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/screening-and-management-of-the-hyperandrogenic-adolescent
- Adigun, O. O., Nguyen, M., Fox, T. J., & Anastasopoulou, C. (2021). Acromegaly. In StatPearls. StatPearls Publishing.
- “Androgen.” (n.d.). In Encyclopedia Britannica. https://www.britannica.com/science/androgen
- Arnaldi, G., & Martino, M. (2019). Androgens in Cushing’s syndrome. Frontiers of Hormone Research, 53, 77–91.
- Ashraf, S., Nabi, M., Rasool, S. ul A., Rashid, F., & Amin, S. (2019). Hyperandrogenism in polycystic ovarian syndrome and role of CYP gene variants: A review. Egyptian Journal of Medical Human Genetics, 20(1), 1–10.
- Aubuchon, M., Liu, Y., Petroski, G. F., Thomas, T. R., & Polotsky, A. J. (2016). The impact of supervised weight loss and intentional weight regain on sex hormone binding globulin and testosterone in premenopausal women. Systems Biology in Reproductive Medicine, 62(4), 283–289.
- Barrett-Connor, E., Young, R., Notelovitz, M., Sullivan, J., Wiita, B., Yang, H. M., & Nolan, J. (1999). A two-year, double-blind comparison of estrogen-androgen and conjugated estrogens in surgically menopausal women. Effects on bone mineral density, symptoms and lipid profiles. The Journal of Reproductive Medicine, 44(12), 1012–1020.
- Clark, R. V., Wald, J. A., Swerdloff, R. S., Wang, C., Wu, F. C. W., Bowers, L. D., & Matsumoto, A. M. (2019). Large divergence in testosterone concentrations between men and women: Frame of reference for elite athletes in sex-specific competition in sports, a narrative review. Clinical Endocrinology, 90(1), 15–22.
- Davis, S. R., & Wahlin-Jacobsen, S. (2015). Testosterone in women—the clinical significance. The Lancet. Diabetes & Endocrinology, 3(12), 980–992.
- Davison, S. L., & Bell, R. (2006). Androgen physiology. Seminars in Reproductive Medicine, 24(2), 71–77.
- de Melo, A. S., Dos Reis, R. M., Ferriani, R. A., & Vieira, C. S. (2017). Hormonal contraception in women with polycystic ovary syndrome: Choices, challenges, and noncontraceptive benefits. Open Access Journal of Contraception, 8, 13–23.
- Escobar-Morreale, H. F., Carmina, E., Dewailly, D., Gambineri, A., Kelestimur, F., Moghetti, P., Pugeat, M., Qiao, J., … & Norman, R. J. (2012). Epidemiology, diagnosis and management of hirsutism. Human Reproduction Update, 18(2), 146–170.
- Filatova, V. A., & Rozhivanov, R. V. (2021). Features of hyperandrogenism in men. Problemy endokrinologii, 67(2), 111–115.
- Hiort, O. (2002). Androgens and puberty. Best Practice & Research. Clinical Endocrinology & Metabolism, 16(1), 31–41.
- Jain, R., Dutta, D., Shivaprasad, K., Maisnam, I., Ghosh, S., Mukhopadhyay, S., & Chowdhury, S. (2012). Acromegaly presenting as hirsuitism: Uncommon sinister aetiology of a common clinical sign. Indian Journal of Endocrinology and Metabolism, 16(Suppl 2), S297–S299.
- Kairys, N., & Schwell, A. (2022). Cushing disease. In StatPearls. StatPearls Publishing.
- Kolodziejczyk, B., Duleba, A. J., Spaczynski, R. Z., & Pawelczyk, L. (2000). Metformin therapy decreases hyperandrogenism and hyperinsulinemia in women with polycystic ovary syndrome. Fertility and Sterility, 73(6), 1149–1154.
- National Cancer Institute. (n.d.-a). “Ovary.” NCI Dictionary of Cancer Terms. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ovary
- National Cancer Institute. (n.d.-b). “Pituitary gland.” NCI Dictionary of Cancer Terms. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pituitary-gland
- National Library of Medicine. (2020). SHBG blood test. MedlinePlus. https://medlineplus.gov/lab-tests/shbg-blood-test/
- National Library of Medicine. (2022a). Acromegaly. MedlinePlus. https://medlineplus.gov/ency/article/000321.htm
- National Library of Medicine. (2022b). Adrenal gland disorders. MedlinePlus; National Library of Medicine. https://medlineplus.gov/adrenalglanddisorders.html
- New, M., Yau, M., Lekarev, O., Lin-Su, K., Parsa, A., Pina, C., Yuen, T., & Khattab, A. (2017). Congenital adrenal hyperplasia. Endotext. MDText.com, Inc.
- O’Connell, M. D. L., & Wu, F. C. W. (2014). Androgen effects on skeletal muscle: Implications for the development and management of frailty. Asian Journal of Andrology, 16(2), 203–212.
- Redmond, G. P. (1998). Androgens and women’s health. International Journal of Fertility and Women’s Medicine, 43(2), 91–97.
- Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome (PCOS): The hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Reviews, 37(5), 467–520.
- Schwartz, R. A. (2020). Gigantism and acromegaly. Medscape. https://emedicine.medscape.com/article/925446-overview
- Shen, M., & Shi, H. (2015). Sex hormones and their receptors regulate liver energy homeostasis. International Journal of Endocrinology, 2015, 294278.
- Sowers, M. F., Beebe, J. L., McConnell, D., Randolph, J., & Jannausch, M. (2001). Testosterone concentrations in women aged 25-50 years: Associations with lifestyle, body composition, and ovarian status. American Journal of Epidemiology, 153(3), 256–264.
- Tuckerman, E. M., Okon, M. A., Li, T., & Laird, S. M. (2000). Do androgens have a direct effect on endometrial function? An in vitro study. Fertility and Sterility, 74(4), 771–779.
- White, T., Jain, J. K., & Stanczyk, F. Z. (2005). Effect of oral versus transdermal steroidal contraceptives on androgenic markers. American Journal of Obstetrics and Gynecology, 192(6), 2055–2059.
- Yildiz, B. O. (2006). Diagnosis of hyperandrogenism: Clinical criteria. Best Practice & Research. Clinical Endocrinology & Metabolism, 20(2), 167–176.
- Zhao, J. V., & Schooling, C. M. (2020). The role of testosterone in chronic kidney disease and kidney function in men and women: A bi-directional Mendelian randomization study in the UK Biobank. BMC Medicine, 18(1), 122.