Hyperandrogenism in Women: Causes, Symptoms, and Treatments

Acne

Acne is a multifactorial skin condition of varying severity, affecting up to 90% of teenagers and potentially persisting into adulthood. Androgens stimulate the sebaceous glands, increasing sebum production. Excess sebum, combined with dead skin cells, can clog hair follicles and lead to acne. Severe acne can cause permanent scarring and often requires intensive medical treatment. A comprehensive article on this topic is available here, and our product Venus can also help with acne related to hyperandrogenism.

Androgenetic Alopecia : Hair Loss

Androgenetic alopecia, or male-pattern hair loss, manifests as the gradual thinning of hair on the scalp, particularly on the crown. This condition is caused by increased sensitivity of hair follicles to androgens, leading to follicle miniaturization and reduced hair density.

Menstrual Disorders

Menstrual disorders include irregular cycles, poor or absent ovulation, which can lead to fertility issues. High levels of androgens can disrupt the hypothalamic-pituitary-ovarian axis, causing menstrual irregularities.

Causes of Hyperandrogenism

Polycystic Ovary Syndrome (PCOS) and Hyperandrogenism

PCOS is the most common cause of hyperandrogenism in women. It is characterized by increased androgen production by the ovaries. This syndrome affects 6 to 15% of women of reproductive age. Clinical signs include irregular menstrual cycles, infertility, hirsutism, and hormonal acne. The presence of numerous ovarian follicles is often detected by ultrasound.

Androgen-Secreting Tumors and Hyperandrogenism

Ovarian or adrenal tumors can secrete excess androgens. These tumors are rare but can lead to severe hyperandrogenism. Symptoms may include rapid hair growth, a deepening voice, and rapid muscle mass increase.

Congenital Adrenal Hyperplasia or Adrenal PCOS and Hyperandrogenism

This genetic disorder results in the excessive production of androgens by the adrenal glands. It is caused by a deficiency in an enzyme needed for cortisol production, leading to overproduction of androgens. Symptoms can appear in childhood and include hirsutism, severe hormonal acne, and menstrual disorders. Adrenal PCOS presents similarly to congenital adrenal hyperplasia (CAH). Both conditions can lead to hyperandrogenism symptoms such as hirsutism, acne, and menstrual irregularities.

How to Distinguish Adrenal PCOS from Congenital Adrenal Hyperplasia - Hormonal Profile

Adrenal PCOS:

• DHEAS: Elevated.
• Testosterone and Androstenedione: Often within normal limits.
• LH/FSH: May be normal or slightly disrupted.
• Cortisol and 17-OHP (17-Hydroxyprogesterone): Generally normal.

Congenital Adrenal Hyperplasia:

• DHEAS: May be elevated.
• Testosterone and Androstenedione: Often elevated.
• 17-OHP: Elevated, used as a diagnostic marker.
• Cortisol: Low or insufficient.
• ACTH: Elevated due to insufficient negative feedback from cortisol.

Hypothyroidism / Cushing's Disease and Hyperandrogenism

Hypothyroidism (low production of thyroid hormones) and Cushing's disease (excess cortisol) can also lead to hyperandrogenism. These conditions affect metabolism and can increase androgen levels. Symptoms include weight gain, fatigue, and menstrual irregularities.

Hypothyroidism:

• TSH: Elevated (in primary hypothyroidism)
• Free T4: Low
• Free T3: Often low or normal
• Antithyroid Antibodies: Present in Hashimoto's thyroiditis

Cushing's Disease:

• Cortisol: Elevated
• ACTH: Elevated in ACTH-dependent forms (pituitary or ectopic)
• Dexamethasone Suppression Test: Poor cortisol suppression
• ACTH Stimulation Test: Elevated

PCOS:

• Testosterone: Often elevated
• Androstenedione: Often elevated
• LH/FSH: LH/FSH ratio often elevated (>2:1)
• DHEAS: May be elevated
• Insulin: Often elevated due to insulin resistance

Severe Hyperprolactinemia and Hyperandrogenism

Hyperprolactinemia, characterized by high prolactin levels, can also lead to increased androgen production. Causes may include pituitary tumors or certain medications. Symptoms can include irregular menstrual cycles, hirsutism, and galactorrhea (milk production outside of pregnancy or breastfeeding).

Diagnosing Hyperandrogenism

The diagnosis of hyperandrogenism involves a combination of clinical evaluation, blood tests, and imaging.

Clinical Evaluation:

• Identifying visible signs of hyperandrogenism such as hirsutism, hormonal acne, and alopecia.
• The degree of hirsutism can be assessed using the Ferriman-Gallwey scale, which measures hair growth in nine body areas.

Blood Tests:

• Measuring serum androgen levels to confirm hormonal excess. Key androgens measured include:
  • Testosterone
  • Dihydrotestosterone
  • Androstenedione
  • Dehydroepiandrosterone sulfate (DHEAS)
  • Dehydroepiandrosterone (DHEA)
• Elevated levels of free testosterone, the bioactive form of the hormone, are particularly indicative of hyperandrogenism.

Imaging:

• Pelvic ultrasound to check for ovarian follicles often associated with PCOS or tumors in the ovaries or adrenal glands.
• Other imaging techniques like CT or MRI may be used to detect adrenal tumors.

Treatments for Hyperandrogenism

Treatments for hyperandrogenism can include lifestyle changes, hormonal therapies, physical hair removal methods, and acne treatments.

Lifestyle Changes:

• Balanced Diet: Reducing high-glycemic foods can help manage symptoms of hyperandrogenism related to PCOS by lowering insulin levels and androgen production.
• Regular Exercise: Exercise helps improve insulin sensitivity and promote weight loss, which can reduce androgen levels and improve symptoms.

Hormonal Therapies:

• Hormonal Contraceptives: Combined oral contraceptives containing estrogens and progestins are often used to reduce androgen production by lowering LH and FSH secretion from the pituitary, thus reducing ovarian androgen production.
• Antiandrogens: Medications like spironolactone inhibit the action of androgens on their receptors. Spironolactone is a competitive inhibitor of androgen receptors and a 5α-reductase inhibitor. Typical doses for treating hirsutism range from 50 to 200 mg per day. Other antiandrogens, like flutamide, may also be used but are less common due to the risk of liver toxicity.

Hirsutism and PCOS Treatments: Physical Hair Removal Methods

• Laser and Electrolysis: These techniques are effective for permanent hair reduction. Laser works through selective thermolysis, destroying hair follicles by targeting melanin pigment. Electrolysis uses an electric current to destroy individual hair follicles.

Acne Treatments:

• Topical Therapies: Include benzoyl peroxide, retinoids (like tretinoin), and topical antibiotics. These treatments help reduce inflammation and prevent hair follicle blockage.
• Oral Antibiotics: Such as doxycycline and minocycline, are used to treat moderate to severe acne by reducing inflammation and bacterial proliferation.
• Isotretinoin: Used for severe acne, isotretinoin is a vitamin A derivative that reduces sebum production and inflammation. Its use requires strict medical supervision due to potential side effects, including teratogenicity risk.

Importance of Management

It's crucial not to underestimate the symptoms of hyperandrogenism, as they can significantly impact self-esteem and quality of life. Regular medical follow-up and long-term symptom assessment are recommended to establish an accurate diagnosis and tailor treatments accordingly. Management should be personalized and may include both medical treatments and lifestyle modifications.

Dietary Supplements to Reduce Hyperandrogenism: Herbs and Vitamins

Managing hyperandrogenism can benefit from incorporating certain herbal and vitamin supplements. Here is a detailed description of some options that may help reduce androgen levels and alleviate symptoms naturally.

Herbs to Reduce Hyperandrogenism:

• Vitex Agnus-Castus (Chaste Tree):

  • Action: Vitex Agnus-Castus is often used to regulate hormonal imbalances by acting on the pituitary gland, increasing progesterone production, and thus reducing androgen secretion.
  • Dosage: Generally, the recommended dose is 20 to 40 mg of dry extract per day.

• Saw Palmetto (Serenoa Repens):

  • Action: Saw Palmetto inhibits 5α-reductase, the enzyme that converts testosterone into dihydrotestosterone (DHT), a more potent form of the hormone.
  • Dosage: Typical doses range from 160 to 320 mg of standardized extract per day.

• Licorice Root (Glycyrrhiza Glabra):

  • Action: Licorice root has anti-androgenic properties by inhibiting testosterone production and increasing cortisol levels, thus reducing androgen production.
  • Dosage: Generally, the recommended dose is 200 to 600 mg of licorice extract per day.

Vitamins and Minerals:

• Vitamin D (Our Rising D3 Vitamin):

  • Action: Vitamin D plays a role in regulating hormone production and can help reduce androgen levels.
  • Dosage: Doses typically vary from 1000 to 4000 IU per day, depending on individual needs and blood levels of vitamin D.

• Zinc (Our Andromaque Supplement for Hyperandrogenism):

  • Action: Zinc is essential for hormonal regulation and can inhibit the conversion of testosterone into DHT.
  • Dosage: Recommended doses vary from 30 to 50 mg per day.

• Magnesium (Our Magnesia Supplement):

  • Action: Magnesium helps regulate insulin and glucose levels, which can indirectly influence androgen levels.
  • Dosage: Recommended doses vary from 300 to 500 mg per day.

• Inositol (Myo-Inositol and D-Chiro-Inositol) (Our Luminaissance Supplement):

  • Action: Inositol forms help regulate insulin levels and can improve ovarian function, thus reducing androgen production.
  • Dosage: Typical doses range from 2000 to 4000 mg per day.
  • Efficacy: Studies have shown that inositol can improve PCOS symptoms, including hyperandrogenism, by enhancing insulin sensitivity.

Using herbal and vitamin supplements can offer a natural approach to managing hyperandrogenism. However, it's crucial to consult a healthcare professional before starting any new supplement, especially if there are underlying medical conditions or if you are taking other medications.

Hyperandrogenism in women is a complex condition that requires a multidisciplinary approach for effective management. Combining therapeutic strategies and lifestyle modifications can help reduce symptoms and improve quality of life. For personalized advice and tailored follow-up, it is essential to consult specialized healthcare professionals