Androgen Excess Disorders
What is Androgen Excess Disorders?
Androgen excess disorders happen when your body produces too much male sex hormone or responds too strongly to normal amounts. Androgens include testosterone and similar hormones that affect hair growth, skin oil production, and reproductive health. Women typically have lower androgen levels than men, but certain conditions can cause these levels to rise.
These disorders affect millions of women and people with ovaries worldwide. The most common cause is polycystic ovary syndrome, but other factors like adrenal gland problems or rare tumors can also trigger high androgen levels. When androgens rise too high, they can disrupt your menstrual cycle, change your appearance, and affect your ability to get pregnant.
Understanding your androgen status starts with blood testing. Measuring Sex Hormone Binding Globulin helps reveal how much active androgen is available in your bloodstream. Lower SHBG means more free testosterone circulating in your body, which amplifies the effects of androgens even when total hormone levels look normal.
Symptoms
- Excess facial or body hair growth, especially on the chin, chest, or back
- Acne that persists beyond teenage years or worsens in adulthood
- Thinning scalp hair or male pattern baldness
- Irregular or absent menstrual periods
- Difficulty getting pregnant or infertility
- Darkening skin patches, especially in body folds
- Deepening voice
- Increased muscle mass
- Weight gain, particularly around the abdomen
Some people with androgen excess have mild symptoms that develop slowly over years. Others may notice sudden changes in their skin or hair. Early stages of the condition may show no obvious signs, making blood testing important for early detection.
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Causes and risk factors
Androgen excess stems from several possible sources in your body. Polycystic ovary syndrome is the most frequent cause, affecting up to 10 percent of women of reproductive age. The ovaries produce too much testosterone, often alongside insulin resistance. Congenital adrenal hyperplasia, a genetic enzyme deficiency, causes the adrenal glands to make excess androgens instead of cortisol. Rare androgen-secreting tumors in the ovaries or adrenal glands can also trigger high hormone levels. Idiopathic hyperandrogenism describes cases where androgen levels rise without a clear cause.
Risk factors include obesity, which lowers SHBG and increases free androgen activity. Family history of androgen disorders raises your likelihood of developing the condition. Insulin resistance and metabolic syndrome create a hormonal environment that favors androgen production. Certain medications like steroids or testosterone supplements can also cause temporary androgen excess. Ethnicity plays a role, with higher rates seen in some populations including women of Mediterranean, South Asian, and Middle Eastern descent.
How it's diagnosed
Doctors diagnose androgen excess through a combination of physical examination, symptom review, and blood testing. Your healthcare provider will ask about your menstrual cycle, hair growth patterns, and family history. They will check for visible signs like excess hair, acne, or hair thinning. Blood tests measure hormone levels including testosterone and related markers.
Sex Hormone Binding Globulin testing is essential for accurate diagnosis because it reveals how much active androgen is circulating in your blood. Rite Aid offers SHBG testing as part of our flagship panel at over 2,000 Quest Diagnostics locations nationwide. Low SHBG increases the amount of free testosterone available to your tissues, even when total testosterone appears normal. Additional tests may include imaging studies to check your ovaries and adrenal glands for abnormalities or tumors.
Treatment options
- Weight loss through balanced nutrition and regular physical activity, which raises SHBG and lowers insulin resistance
- Low glycemic diet to manage blood sugar and reduce insulin spikes that trigger androgen production
- Resistance training and cardiovascular exercise to improve insulin sensitivity
- Hormonal birth control pills to regulate menstrual cycles and reduce androgen effects
- Anti-androgen medications like spironolactone to block hormone receptors
- Metformin to improve insulin resistance in people with metabolic issues
- Hair removal treatments for cosmetic management of excess hair growth
- Topical acne treatments or prescription medications for persistent skin issues
- Fertility treatments when pregnancy is desired
- Surgical removal if a hormone-secreting tumor is identified
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Frequently asked questions
Androgen excess disorders occur when your body produces too much male sex hormone or has too much active hormone in circulation. These conditions affect hair growth, skin, menstrual cycles, and fertility. The most common form is polycystic ovary syndrome, but other causes include adrenal problems and rare tumors.
Polycystic ovary syndrome is the leading cause, affecting up to 10 percent of women. Other causes include congenital adrenal hyperplasia, androgen-secreting tumors, and insulin resistance. Obesity lowers SHBG, which increases free androgen activity even when total hormone levels are normal.
Sex Hormone Binding Globulin binds to testosterone and limits how much is available to your tissues. Low SHBG means more free testosterone circulates in your bloodstream, amplifying androgen effects. This test reveals cases where total testosterone appears normal but free testosterone is actually high.
Existing hair may not disappear completely once the follicle has changed. However, treating the underlying hormone imbalance can slow new hair growth and prevent worsening. Many people combine medical treatment with hair removal methods like laser therapy or electrolysis for best cosmetic results.
Yes, high androgen levels often disrupt ovulation and menstrual cycles, making conception more difficult. Many women with polycystic ovary syndrome face fertility challenges. Treatment with lifestyle changes, medications like metformin, or fertility drugs can restore ovulation and improve pregnancy chances.
Weight loss of just 5 to 10 percent can significantly improve androgen levels and raise SHBG. A low glycemic diet reduces insulin spikes that trigger androgen production. Regular exercise improves insulin sensitivity and helps regulate hormone balance naturally.
Polycystic ovary syndrome is the most common type of androgen excess, but not all androgen disorders are PCOS. Other causes include congenital adrenal hyperplasia, tumors, and idiopathic hyperandrogenism. Accurate diagnosis requires blood testing and sometimes imaging to identify the specific cause.
Initial testing establishes your baseline hormone levels and SHBG status. After starting treatment, retest every 3 to 6 months to track progress. Once your levels stabilize, annual testing helps monitor long-term management and catch any changes early.
Men rarely experience androgen excess disorders because their bodies naturally produce high testosterone levels. However, conditions like steroid use, certain tumors, or adrenal disorders can cause abnormally elevated androgens. In men, this may cause aggression, acne, shrinking testicles, or infertility.
Hormonal birth control pills reduce androgen production and regulate cycles. Anti-androgen drugs like spironolactone block hormone receptors and reduce symptoms like hair growth and acne. Metformin improves insulin resistance, which indirectly lowers androgen levels in people with metabolic issues.