Hyperandrogenism (Excess Androgen in Females): Symptoms, Causes, Diagnosis & Treatment

Introduction

Persistent acne, unwanted facial hair, and irregular periods may seem like separate problems bothering you, but they can all point to the same underlying issue. If you have been experiencing one or more of these symptoms, you may be asking yourself whether there is a deeper cause suggestive of a hormonal issue. 

Hyperandrogenism means that the body has higher-than-usual levels or effects of androgens, a group of hormones that includes testosterone. Although androgens are often called “male hormones,” both men and women have them. In women and adolescent girls, too much androgen activity can lead to symptoms such as unwanted facial or body hair, acne, and irregular periods¹. 

Understanding hyperandrogenism, its symptoms, causes, and treatment may help individuals in the early detection and effective management of this condition. 

What Is Hyperandrogenism?

Hyperandrogenism occurs when androgen levels are higher than expected or when the body is especially sensitive to these hormones. The main androgen often measured is testosterone. In some tissues, testosterone can be changed into its active form called dihydrotestosterone (DHT). 

The most common visible sign is hirsutism, which means extra coarse hair growth on the face or body in areas where hair is usually less noticeable in women. Polyendocrine metabolic ovarian syndrome (PMOS) is the most common cause. Treatment is important because symptoms such as unwanted hair growth, acne, and changes in periods can affect physical health, confidence, and quality of life^1,2. 

How Do Androgens Affect the Female Body?

Women naturally make small amounts of androgens, mainly in the ovaries and adrenal glands. These hormones support normal reproductive health, muscle and bone strength, sexual desire, and general wellbeing^1,3. 

When androgen levels or effects become too high, symptoms may include unwanted facial or body hair, acne, oily skin, scalp hair thinning, irregular periods, or difficulty getting pregnant^1,3. Sudden symptoms, such as a rapidly deepening voice or fast-growing hair, should be checked promptly by a doctor. 

Causes of Hyperandrogenism

Hyperandrogenism can have several causes. PMOS is the most common cause, but less common hormone conditions, certain medicines, and rarely androgen-producing tumours can also be involved. Commonly considered causes include¹: 

• PMOS: The most common cause of high androgen levels in women of reproductive age. 
• Congenital adrenal hyperplasia: An inherited condition in which the adrenal glands produce too much androgen. 
• Androgen-secreting ovarian or adrenal tumours: Rare growths that can produce large amounts of androgens and may cause symptoms that appear suddenly or worsen quickly. 
• Ovarian hyperthecosis: A condition in which the ovaries produce too much androgen, most commonly after menopause. 
• Cushing syndrome: A hormonal disorder that can cause increased androgen production. 
• Hyperprolactinaemia: A condition in which high levels of the hormone prolactin can contribute to increased androgen levels. 
• Acromegaly: A rare condition caused by excess growth hormone that may lead to high androgen levels. 

Symptoms of Hyperandrogenism

Hyperandrogenism can affect the menstrual cycle, skin, hair, and reproductive health. Symptoms include: 

• Excess facial or body hair^4,5. 
• Acne^4,5.
• Oily skin⁵
• Hair loss and thinning^4,5.
• Irregular or missed periods¹
• Difficulty getting pregnant¹
• Deep, low-pitched voice¹
• Increased muscle growth⁵
• Enlarged clitoris⁵

How Is Hyperandrogenism Diagnosed?

Doctors diagnose hyperandrogenism by asking about symptoms and periods, doing a physical examination, and ordering blood tests. Imaging tests may be used when the doctor needs to look for a specific cause. Diagnosis may include: 

• Medical history and physical examination: The doctor may ask about periods, acne, hair growth, hair thinning, weight changes, medicines, and family history. They may also check for signs such as acne, hirsutism, and scalp hair thinning^1,6 
• Blood tests: These may measure total testosterone, free testosterone, DHEAS (dehydroepiandrosterone sulphate), androstenedione, and 17-hydroxyprogesterone (17-OHP) to look for androgen excess and possible causes^6,7. 
• Additional hormone tests: Prolactin, thyroid-stimulating hormone, follicle-stimulating hormone, and luteinising hormone levels may be checked to rule out underlying hormonal conditions¹.
• maging tests: Pelvic ultrasound to examine the ovaries, and CT scan or MRI of the adrenal glands or ovaries if a tumour is suspected¹.

Treatment of Hyperandrogenism

Treatment depends on the cause, the symptoms, overall health, and whether pregnancy is planned. Your doctor may suggest one or more options and will tailor the plan to your needs. Options may include: 

• Lifestyle changes: Regular physical activity, balanced eating, and weight management may help improve symptoms and blood sugar control, especially in people with PCOS. Lifestyle changes are usually part of care but may not be enough on their own^1,8. 
• Combined oral contraceptive pills: These are often used when pregnancy is not desired. They can help regulate periods and reduce acne and unwanted hair growth by lowering androgen activity^1,9. 
• Anti-androgen medicines: These medicines reduce the effects of androgens on the skin and hair. They are usually prescribed with reliable contraception because they may be unsafe during pregnancy^1,8,9.
• Hair removal treatments: Shaving, waxing, bleaching, laser hair removal, or electrolysis can help manage unwanted hair growth^1,8,9. 
• Surgery: Surgery may be needed for androgen-secreting tumours¹. 
• Fertility treatment: Women trying to conceive may need medicines to stimulate ovulation if hyperandrogenism affects fertility¹.

Possible Complications of Untreated Hyperandrogenism

If hyperandrogenism is severe or continues for a long time without treatment, it may be linked with other health problems, especially when PMOS or insulin resistance is present. Possible concerns include¹⁰: 

• High blood pressure: Increased risk of severe, persistent hypertension 
• Heart problems: Some people may have higher risks related to blood pressure, cholesterol, diabetes, or weight, depending on the underlying cause 
• Type 2 diabetes or poor blood sugar control: High androgen levels may worsen insulin resistance and diabetes. 
• Obesity: Excess weight, especially around the abdomen may become more severe 
• Disrupted sleep: Increased risk of obstructive sleep apnoea and related breathing difficulties 
• Changes in the lining of the uterus: In people who have long gaps between periods, the lining of the uterus may become too thick over time 
• Higher risk of cancer: Ongoing irregular periods may increase the risk of endometrial hyperplasia and, in some cases, endometrial cancer 

Prevention Tips for Hyperandrogenism

Hyperandrogenism cannot always be prevented. However, these habits may support hormone health and help manage symptoms or related risks¹¹: 

• Healthy weight maintenance 
• Regular moderate exercise 
• Balanced, nutritious diet 
• Control blood sugar levels through a healthy lifestyle 
• Get regular health monitoring 

When Should You Consult a Doctor?

Consult your doctor if you have any of the following symptoms:¹ 

• Excess facial or body hair 
• Persistent acne that does not improve with treatment 
• Increased hair loss or thinning 
• Irregular or absence of periods 
• Infertility or difficulty in conceiving 
• Symptoms that appear suddenly or worsen quickly, such as rapid hair growth, deepening of the voice, or enlargement of the clitoris, as these may require urgent evaluation 

Conclusion

Hyperandrogenism is a hormone-related condition that can affect the skin, hair, menstrual cycle, fertility, and overall health. Symptoms such as unwanted facial or body hair, persistent acne, hair thinning, or irregular periods can be upsetting, but early medical advice can help identify the cause and guide treatment. With the right care, which may include lifestyle measures, medicines, hair removal options, and regular follow-up, many people can manage symptoms and improve quality of life. If symptoms appear suddenly, worsen quickly, or interfere with daily life, speak with a doctor for proper assessment and advice. 

Frequently Asked Questions (FAQs)

References

1. Sharma A, Welt CK. Practical Approach to Hyperandrogenism in Women. Med Clin North Am. 2021;105(6):1099-1116. doi:10.1016/j.mcna.2021.06.008 https://pubmed.ncbi.nlm.nih.gov/34688417/

2. Esquivel-Zuniga MR, Kirschner CK, McCartney CR, Solorzano CMB. Non-PCOS Hyperandrogenic Disorders in Adolescents. Semin Reprod Med. 2022;40(1-02):42-52. doi:10.1055/s-0041-1742259  https://pubmed.ncbi.nlm.nih.gov/35052005/

3. Bianchi VE, Bresciani E, Meanti R, Rizzi L, Omeljaniuk RJ, Torsello A. The role of androgens in women’s health and wellbeing. Pharmacol Res. 2021;171:105758. doi:10.1016/j.phrs.2021.105758  https://pubmed.ncbi.nlm.nih.gov/34242799/

4. Yildiz BO. Diagnosis of hyperandrogenism: clinical criteria. Best Pract Res Clin Endocrinol Metab. 2006;20(2):167-176. doi:10.1016/j.beem.2006.02.004 https://pubmed.ncbi.nlm.nih.gov/16772149/

5. Makrantonaki E, Zouboulis CC. [Hyperandrogenism, adrenal dysfunction, and hirsutism]. Hautarzt Z Dermatol Venerol Verwandte Geb. 2020;71(10):752-761. doi:10.1007/s00105-020-04677-1 https://pubmed.ncbi.nlm.nih.gov/32857168/

6. Rachoń D. Differential diagnosis of hyperandrogenism in women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes Off J Ger Soc Endocrinol Ger Diabetes Assoc. 2012;120(4):205-209. doi:10.1055/s-0031-1299765 https://pubmed.ncbi.nlm.nih.gov/22421986/

7. Stanczyk FZ. Diagnosis of hyperandrogenism: biochemical criteria. Best Pract Res Clin Endocrinol Metab. 2006;20(2):177-191. doi:10.1016/j.beem.2006.03.007 https://pubmed.ncbi.nlm.nih.gov/16772150/

8. Hock DL, Seifer DB. New treatments of hyperandrogenism and hirsutism. Obstet Gynecol Clin North Am. 2000;27(3):567-581, vi-vii. doi:10.1016/s0889-8545(05)70156-x https://pubmed.ncbi.nlm.nih.gov/10958004/

9. Moghetti P, Toscano V. Treatment of hirsutism and acne in hyperandrogenism. Best Pract Res Clin Endocrinol Metab. 2006;20(2):221-234. doi:10.1016/j.beem.2006.03.003 https://pubmed.ncbi.nlm.nih.gov/16772153/

10. Capatina C, Scafa-Udriste A, Ghinea A, Dumitrascu A, Poiana C. Multiple complications of severe hyperandrogenism in a postmenopausal woman. Endocr Abstr. Published online May 13, 2016. doi:10.1530/endoabs.41.EP653 https://www.academia.edu/55312221/Multiple_complications_of_severe_hyperandrogenism_in_a_postmenopausal_woman

11. Zapała B, Marszalec P, Piwowar M, Chmura O, Milewicz T. Reduction in the Free Androgen Index in Overweight Women After Sixty Days of a Low Glycemic Diet. Exp Clin Endocrinol Diabetes. 2024;132(1):6-14. doi:10.1055/a-2201-8618 https://pubmed.ncbi.nlm.nih.gov/38237611/

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