Hyperandrogenism

Hyperandrogenism is a condition characterized by elevated levels or effects of androgens in the body, including testosterone, androstenedione, and DHEA. It most commonly affects women and can present with hirsutism (excess facial or body hair), acne, and androgenic alopecia, often accompanied by menstrual irregularities or infertility. In rare cases, markedly high androgens cause virilization, such as clitoral enlargement or deepening of the voice.

Causes are diverse and can be categorized as ovarian, adrenal, or exogenous. The most frequent cause in premenopausal women is polycystic ovary syndrome (PCOS). Other etiologies include nonclassic congenital adrenal hyperplasia, androgen-secreting tumors (ovarian or adrenal), Cushing syndrome, and medications or supplements with androgenic activity or antiandrogen effects.

Diagnosis relies on clinical assessment and laboratory testing. Common investigations include serum total testosterone, free testosterone, sex hormone–binding globulin (SHBG), and DHEA-S, with interpretation guided by clinical features. It is important to exclude pregnancy. Pelvic ultrasound may aid in PCOS evaluation, but a normal ultrasound does not exclude hyperandrogenism if clinical and biochemical evidence are present.

Management aims to control symptoms, address the underlying cause, and reduce long-term risks. For PCOS, lifestyle modification and weight loss are foundational, with combined estrogen-progestin oral contraceptives used to regulate menses and reduce androgenic symptoms. Antiandrogens such as spironolactone or finasteride can help with hirsutism and acne (not for use in pregnancy). Fertility treatment may be pursued if pregnancy is desired. In adrenal or ovarian tumors or in CAH, specific treatments (glucocorticoids or surgical intervention) are indicated. Regular follow-up focuses on symptom control and metabolic risk factors.