Androgenisation (masculinisation, virilisation), means a hormonal change in the woman through male sex hormones. These are testosterone and androstendione. These hormones lead to various physical changes as well as to changes in behaviour.

Cause of androgenisation

Androgenisation results from an increased supply of androgens. These are the male hormones testosterone and androstendione. In men these hormones lead to the development of primary (testicular development) and secondary (voice, body hair) sexual characteristics.

Women also carry a certain amount of this hormone in their bodies. If the androgen metabolism is disturbed, this can lead to increased production of the male sex hormones. The androgens are produced in the adrenal cortex and the ovaries (ovaries) and are controlled by the pituitary gland.

Tumours or disorders of this control can lead to an increased supply of androgens. These then lead to the typical clinical symptoms. A relatively common clinical picture is the adrenogenital syndrome.

This syndrome is accompanied by an enzyme deficiency, which leads to an increased supply of male hormones in the adrenal cortex. The polycystic ovarian syndrome can also be a trigger. An increased supply of hormones can also be caused by taking anabolic steroids or other hormone preparations.

The symptoms of androgenisation include all the manifestations that are typical for a man. Hirsutism – What can be done about it? In addition, the female sexual characteristics can be reduced.

This means that the breasts can regress, the menstrual cycle is disturbed and women become infertile. However, all symptoms are usually reversible with appropriate therapy. – Hirsutism: increase in body and facial hair in the woman which leads to a male type of hair.

As a rule, no new hair grows, but the existing downy hair is transformed into thicker terminal hair. – Alopecia: This is a typical male pattern hair loss. It can develop receding hairline or a so-called monk’s tonsure.

  • Acne: Frequently, increased testosterone production leads to increased production of the sebaceous glands. This can lead to impure skin and even acne. – Enlargement of the clitoris: The clitoris is the erectile organ in women.

Testosterone can cause it to enlarge significantly (clitoral hypertrophy). Changes of this kind have been observed especially in female athletes. – Deepening of the voice: The voice can become deeper through an increased effect of androgens on the vocal cords and larynx.

  • Increase in muscle mass: The muscle mass increases due to the increased action of androgens. This is particularly obvious in athletes who take more anabolic steroids. As a rule, the suspected diagnosis is made by the clinical signs and the medical history.

The blood values show elevated hormones (androgens, pituitary and adrenal cortex hormones) and can confirm the diagnosis. In order to rule out hormone-producing tumours, MRI is used to image the head and ultrasound or CT to examine the abdomen. As the disease usually progresses over a long period of time, therapy over a longer period of time is often necessary.

In order to be able to treat androgenisation sustainably, the actual cause should be found. Hormone-producing tumours, for example, should be removed or treated. However, if enzyme defects or organ sensitivity to androgens are the cause, hormone treatment is necessary.

These act on the production of androgens in the ovaries and adrenal glands and inhibit their formation. However, they can also have a direct influence on the control at the pituitary gland or the actual organ action. If a causal therapy of androgenisation is possible, the prognosis is very good and the symptoms can subside again.

If such a therapy is not possible, a long-term therapy with hormones is often necessary. If the drugs are discontinued or not taken according to the prescription, the symptoms may return.