What’s the cause for hyperandrogenism in females & treatment?

Before talking about hyperandrogenism in females, let’s first understand about androgens and its types!

What are Androgens?

Androgens are a group of sex hormones that give men their male characteristics. These include deepening of voice, the growth of facial and body hair, increased muscle mass, and penile growth. But both men and women produce androgens, though the amount of production will vary in both of them.

Moreover, women do need a small amount of androgen to produce the female sex hormones called estrogens. But the excessive production of androgens in the ovaries and adrenals can lead to hyperandrogenism.

What are the types of androgen?

Testosterone is the predominant androgen found in all genders. Other androgens include:

• Androstenedione.
• Dehydroepiandrosterone (DHEA).
• DHEA sulfate (DHEA-S).
• Dihydrotestosterone (DHT).

What is hyperandrogenism in females?

The ovaries, adrenal glands, fat cells and skin cells make the female body’s supply of androgens. Hyperandrogenism is the defining feature of women with PCOS. It is caused by the disruption of normal ovarian or adrenal function which results in the production of excess androgens.

What are the symptoms of hyperandrogenism?

• Hirsutism: It is a condition in which women have excess dark or coarse hair growth in male-like pattern such as face, chest and back.
• Alopecia: It causes your hair to come out in clumps. But the amount of hair loss is different in everyone. It happens because high levels of androgens including DHT can shrink your hair follicles causing hair to grow out looking thinner and more brittle, as well as fall out faster. DHT can also make it take longer for your follicles to grow new hairs once old hairs fall out which may result in baldness over time.
• Acne:  Acne is one of the symptoms of hyperandrogenism. This occurs because high level of androgens, or hypersensitivity of the sebaceous glands (oil-producing gland) to a normal level of androgens causes an increase in sebum production which can trigger an acne outbreak.
• Anovulation: It happens when an egg doesn’t release from your ovary during your menstrual cycle. Hyperandrogenism 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.
• Insulin resistance: Insulin resistance is when cells in muscles, fat, and liver don’t respond well to insulin and can’t easily take up glucose from your blood. As a result, your pancreas makes more insulin to help glucose enter your cells.

How to diagnose hyperandrogenism?

Hyperandrogenism can be diagnosis can be done as following:

• Clinical hyperandrogenism: These are the characteristics that can be present on your physical self easily. It can either be objective when observed by a physician, or subjective when perceived by the patient. It is the presence of hirsutism, acne, androgenic alopecia, insulin resistance and anovulation.

• Biochemical hyperandrogenism: It refers to an elevating serum level of one or more androgens, that is, total testosterone, free testosterone, dehydroepiandrosterone sulfate, and androstenedione.

If there are clinical symptoms or signs to suggest hyperandrogenism, then biochemical investigations may be useful to identify the exact cause.

These biochemical tests for hormones are as follows:

• FSH (follicle stimulating hormone)
• LH (luteinizing hormone)
• Oestradiol
• Prolactin
• Testosterone
• SHBG (sex hormone binding globulin)
• 17-hydroxyprogesterone
• DHEAS (Dehydroepiandrosterone sulfate)
• Thyroid function
• Pelvic ultrasound scan to evaluate ovarian cysts

What are the causes of hyperandrogenism in females?

There are various causes of hyperandrogenism in females. Some of them are as follows:

Polycystic ovary syndrome (PCOS):

PCOS is the most popular cause of hyperandrogenism. It 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. This hormonal imbalance can also lead to chronic anovulation, in which the ovaries fail to release mature eggs. These cases of ovulatory dysfunction are linked to infertility and also menstrual disturbances.  

To know more about PCOS, visit these articles.

why PCOS is common in India and what can you do to treat PCOS at home?

A comprehensive guide- PCOS and Dietary Habits

Congenital Adrenal hyperplasia:

Congenital adrenal hyperplasia is a group of autosomal recessive disorders that cause a lack of an enzyme necessary for the production of cortisol and aldosterone produced by the adrenal cortex. The enzyme that causes most of the congenital adrenal hyperplasia is 21-hydroxylase. The heightened androgen levels seen in congenital adrenal hyperplasia affect the hypothalamic–pituitary–gonadal axis. These androgen levels can also affect the ovaries, which can lead to infertility as well as chronic anovulation.

Cushing’s syndrome:

Cushing’s disease occurs when the body has too much cortisol, a stress hormone, either by overproduction or via medication. Overproduction may be due to growth on the adrenal gland or pituitary gland, which helps with hormone regulation. This growth may lead to high levels of a hormone that helps with cortisol production which can increase androgens levels in the body.

Menopause:

The end of ovulation and the beginning of menopause can result in hyperandrogenism. During this transition, the body stops releasing estrogen at a faster rate than it stops releasing androgens. In some cases, the difference between the lower estrogen levels and higher androgen levels can produce hyperandrogenism. A decrease in sex hormone levels while the free androgen index increases can also contribute to this process.

(Source:https://en.wikipedia.org/wiki/Hyperandrogenism#:~:text=It%20occurs%20in%20approximately%205,of%20cancers%2C%20and%20certain%20medications)

How to treat hyperandrogenism?

For the treatment, you should consult with your doctor first. He will provide you with the best suitable treatment option for you. All treatments have their advantages as well as disadvantages, and medications may carry side effects and risks.

Birth Control:

If you are not trying to get pregnant, you can use hormonal birth control pills to reduce androgens. You can try combination of estrogen-progesterone birth control first to treat PCOS symptoms.

Anti-Androgen Drugs:

Another possible treatment is anti-androgen medication, which reduces the effects of excess androgens. This may be used alone or in combination with birth control pills. They should not be used if you are trying to get pregnant.

Insulin Reducing Drugs:

There are several medication that you can use for the insulin resistance and metformin is one of them. Metformin which improves insulin sensitivity, you may use it to treat PCOS-related androgen symptoms, including unwanted hair growth and acne. You can also take it if you are trying to get pregnant.

Hair Removal:

Excess hair often treated with a combination of approaches, including oral contraceptives with or without an anti-androgen which can lower levels or block actions of androgen on hair follicles. Oral contraceptives are often combined with anti-androgens to improve their clinical effect and to prevent pregnancy, since accidental exposure of the male fetus to anti-androgens can harm fetal development.

This medical therapy usually is combined with mechanical methods of hair removal, such as electrolysis or lasers. Electrolysis is the insertion of an electrode to destroy individual hair follicles. It is ideal for removing small areas of sparse hair of any color. On the other hand, laser therapy destroys hair by targeting the pigment melanin in the hair follicle and is ideally suits for dark-haired, light-skinned individuals.

Acne Treatments:

Based on the severity of your acne, different treatment options are available to reduce sebum production, pimple formation and painful inflammation. You can treat your acne problem with the combination of oral contraceptives and anti-androgens. But you should not take these medications without doctors prescription.

Bottom line:

Hyperandrogenism is caused by the disruption of normal ovarian or adrenal function which results in the production of excess androgens. The symptoms of hyperandrogenism are hirsutism, acne, infertility and so on. Furthermore, PCOS is the most popular cause of the hyperandrogenism. Other medical conditions are congenital adrenal hyperplasia, menupause and cushing’s syndrome. These conditions are responsible for the hormonal imbalance in your body.

The treatment for the hyperandrogenism are birth control pills, anti-androgen drugs. Also, insulin resistance drugs such as metformin, and hair removal treatment such as electrolysis and lasers.

If you are struggling shedding weight. You can talk to us by taking this assessment: Click here

For more information click here