Where does excess androgens come from?
Androgens in women are produced in the ovaries, adrenal glands and adipose tissue. Their activity depends not only on the amount of the hormone in the blood, but also on the protein that binds sex hormones: the less it is, the more free testosterone acts on the skin and hair follicles. Therefore, with obesity and insulin resistance, the manifestations increase even with a moderate increase in hormones. The receptor form is isolated separately when the test levels are normal, but the skin and hair follicles are overly sensitive to the usual amount of androgens.
- Ovarian form - most often with PCOS
- Adrenal form - congenital dysfunction of the adrenal cortex
- Mixed form
- Receptor - with normal tests
- Tumor - rare, but requires exclusion
- Medicinal - against the background of certain medications
Causes and risk factors
The most common cause is polycystic ovary syndrome, which disrupts the maturation of follicles and increases the production of androgens. The second place is occupied by the non-classical form of congenital dysfunction of the adrenal cortex, associated with enzyme deficiency and detected by the level of 17-OH-progesterone. Less commonly, excess hormones are caused by tumors of the ovaries and adrenal glands, Cushing's syndrome, high prolactin and thyroid diseases. Excess weight and insulin resistance play a significant role, closing a vicious circle: excess insulin increases the production of androgens.
- Polycystic ovary syndrome
- Congenital dysfunction of the adrenal cortex
- Insulin resistance and obesity
- Hyperprolactinemia
- Cushing's syndrome
- Tumors of the ovaries and adrenal glands
- Taking anabolic and some hormonal drugs
Symptoms
The most noticeable symptom is hirsutism, the growth of coarse pigmented hair where women usually do not have it: above the upper lip, on the chin, chest, abdomen, back. The skin becomes oily and persistent acne appears, which does not respond well to regular care. The hair on the head, on the contrary, thins according to the male pattern. The cycle is disrupted: menstruation comes rarely, delays lengthen, ovulation does not occur every month, so difficulties often arise with conception. With a pronounced excess, signs of virilization appear.
- Growth of coarse hair on the face, chest, abdomen
- Persistent acne and oily skin
- Thinning hair on the head
- Infrequent or absent periods
- Difficulty getting pregnant
- Weight gain, often in the abdominal area
- Darkening of skin folds due to insulin resistance
What examinations are needed
The examination begins on days 2–5 of the cycle, if menstruation continues. Total and free testosterone, DHEA sulfate as a marker of adrenal origin, and 17-OH-progesterone are determined to exclude congenital dysfunction of the adrenal cortex. Additionally, prolactin, TSH, LH and FSH are assessed. A pelvic ultrasound shows the structure of the ovaries, and if a tumor is suspected, a CT or MRI of the adrenal glands is prescribed. Be sure to check glucose and carbohydrate metabolism indicators, as well as the lipid profile.
- Total and free testosterone
- DHEA sulfate
- 17-OH-progesterone
- Prolactin, TSH, LH and FSH
- Ultrasound of the uterus and ovaries
- Glucose, insulin, lipid profile
- CT or MRI of the adrenal glands if a tumor is suspected
Treatment
Tactics depend on the reason and the woman’s goals. If you are overweight, losing even a few kilograms of body weight reduces androgen levels and often restores the cycle - this is the first line of treatment. To control skin manifestations and cycle regularity, combined hormonal contraceptives are used, if necessary with an antiandrogenic effect; for insulin resistance, drugs that increase insulin sensitivity are added. If pregnancy is planned, the regimen is changed and ovulation is stimulated. Cosmetological hair removal methods complement, but do not replace, treatment. All medications are prescribed by a doctor.
- Weight loss and regular physical activity
- Combined hormonal contraceptives
- Antiandrogen drugs as prescribed by a doctor
- Drugs that increase insulin sensitivity
- Stimulation of ovulation when planning pregnancy
- Glucocorticoids for the adrenal form
- Laser hair removal and skin care as a supplement
