Hyperandrogenemia describes a dysfunction of the ovaries and/or adrenal glands, which can be triggered by various causes and occurs in different forms. The condition results from excessive secretion of male sex hormones (androgens). Without treatment, hyperandrogenemia often results in infertility and a resulting unfulfilled desire to have children.
What is hyperandrogenemia?
Hyperandrogenemia is an excess of male sex hormones in women. These are produced by men, but equally by women, just as men produce female sex hormones in some organs. Thus, the disease belongs to hormonal disorders. Androgens are substances that promote the development and formation of male sexual characteristics. Ultimately, the balance between male and female sex hormones always plays a decisive role. In case of an unfavorable balance, the corresponding clinical symptoms occur. In women, male sex hormones are produced primarily in the ovaries, but the adrenal glands and adipose tissue also produce male hormones. Hyperandrogenemia can be triggered by various underlying diseases or functional disorders. Therefore, in case of suspicion, the main site of hormone formation must be determined in the first place.
Causes
A variety of causes are possible for hyperandrogenemia. Not infrequently, various diseases are the trigger for the excess of male hormones, for example, a tumor on the adrenal gland, pituitary gland or ovary, which produces androgens, but depending on the location can usually be removed well surgically. Numerous affected individuals suffer from a hormone disorder such as polycystic ovary syndrome. This metabolic disorder causes too many male hormones to be produced in the ovaries. The causes of this have not yet been fully elucidated. Obesity and diabetes are also thought to promote the development of the disease.
Symptoms, complaints and signs
Hyperandrogenemia is manifested by various symptoms that can vary in severity depending on the extent. Typical symptoms of hyperandrogenemia in women include increased growth of body hair, falling out of body hair, formation of baldness (receding hairline), and an impure skin appearance, including acne. Affected women take on a generally more masculine appearance with a deeper voice, and they also develop excessive fat on the epidermis due to increased sebum secretion. There is an increase in libido, and at the same time menstrual irregularities occur, such as the absence of periods. Infertility may occur. In severe cases, it is even possible that the voice deepens and the clitoris enlarges. However, these are rather rare symptoms. In this case, further clarification is necessary. This is especially true if the symptoms develop very quickly. Then it should be checked whether there is no tumor in the ovary or adrenal gland that produces the large amounts of male hormones and thus causes these unusual symptoms. In most cases, however, hyperandrogenemia manifests itself only by mild signs, so that the disease is often detected late or not at all.
Diagnosis and course of the disease
If it is suspected that hyperandrogenemia is present, the physician can determine this quite easily. He first arranges for a blood test. In this, the concentration of male hormones in the blood is checked. If there is an excess, the causes are then investigated. This means that it is determined which organ is the main site of formation. The appropriate treatment is then initiated on the basis of this. In addition, the so-called ACTH stimulation test is available, which can be used to check the function of the adrenal cortex. Hyperandrogenemia cannot be cured, but there are now various effective treatment methods that enable the affected patient to live a symptom-free life and also to fulfill her desire to have children.
Complications
As a rule, hyperandrogenemia results in masculinization of the affected person. This leads primarily to aesthetic complaints, as most patients no longer feel comfortable with their bodies.It is not uncommon for depression and other psychological complaints to develop, which can have a very negative effect on the patient’s everyday life. Furthermore, infertility also occurs. In most cases, the affected person will no longer be able to have children if the hyperandrogenemia is not treated. The unfulfilled desire to have children can lead to considerable psychological discomfort not only for the patient himself, but also for his partner, which usually has to be examined and treated by a psychologist. Cycle disorders continue to occur and the patient’s hair falls out. The skin becomes very blemished and acne is not uncommon. Due to the reduced aesthetics, inferiority complexes or general dissatisfaction and irritability often develop. Treatment of hyperandrogenemia is always causal and depends on the underlying disease. In the case of a tumor, this can lead to further complications, although these depend on the type and extent of the tumor. In most cases, however, life expectancy is not affected by hyperandrogenemia.
When should you see a doctor?
Disorders of the female menstrual cycle should generally be clarified by a doctor as soon as they occur over several months. If there is a cessation of menstruation, a shortened bleeding phase or heavy bleeding, a visit to the doctor is advisable. Women who do not use hormonal contraception should show increased vigilance if ovulation fails to occur. If ovulation fails to occur for several months in a row, a visit to the doctor is advised. If there is a desire for pregnancy that remains unfulfilled despite all efforts, a doctor should be consulted. People suffering from diabetes or women who are very overweight should consult a doctor as soon as they develop a feeling of discrepancy. Changes in weight, skin blemishes or hair loss are considered unusual and should be investigated. In many cases, these are warning signs from the body that need treatment. If an oily complexion suddenly appears, acne develops on the face, or mood swings begin, a doctor should be consulted. In case of behavioral abnormalities, a depressive or hyperactive appearance as well as melancholic behavioral traits, a doctor is needed. A particularly euphoric mood, sudden aggressiveness, increased irritability and a permanent change of opinion must be discussed with a doctor. In rare cases, a change in voice pitch occurs. If this symptom occurs, a visit to the doctor should be made as soon as possible.
Treatment and therapy
The treatment of hyperandrogenemia depends on two factors: This is the extent of the disease on the one hand and the cause on the other. Therefore, it is important to adequately determine the trigger. If hyperandrogenemia occurs due to a metabolic disorder, such as polycystic ovary syndrome, the birth control pill is usually used because it balances the woman’s hormone balance. This treatment is also used for an affected woman who wishes to have children and lasts until the hormone balance has returned to normal. As a result, the excess of androgens decreases more and more to the normal level. The dosage of hormones provided by the pill depends on the extent of the hyperandrogenemia. It must therefore be tailored to the individual woman. The birth control pill is discontinued in women who wish to have children after the androgen balance has normalized. It is then replaced with Clomifien, an active ingredient that triggers ovulation and thus forms the basis for a healthy pregnancy. If there is increased formation of male hormones due to hyperfunction of the adrenal glands, the formation of hormones can be slowed down by administering low doses of glucocorticoids, which includes cortisone. Hyperandrogenemia is also caused in rare cases by a hormone-producing tumor, which should be surgically removed.
Outlook and prognosis
Prognosis is determined based on the cause of the disease as well as the progression of the disease. Normally, the sooner a diagnosis is made and therapy is started, the better the prospects for cure. In the case of an existing metabolic disease, hormone preparations are usually administered. These bring the hormone balance back into equilibrium and alleviate the symptoms.Long-term therapy is initiated, since a relapse is to be expected if the medication is discontinued. If naturally occurring hormonal changes occur later in the course of development, freedom from symptoms is often documented and treatment is terminated. Although relief is achieved through the administration of medication, side effects and sequelae can occur. In addition to a change in libido, behavioral changes also occur. The consequences are not always desirable or pleasant for the person affected. In the case of an existing tumor disease, the prognosis of hyperandrogenemia depends on the prospect of a cure for the cancer. If the tumor can be completely removed and follow-up treatment is successfully completed, there is a good chance of a cure for hyperandrogenemia. Otherwise, symptomatic treatment to relieve pain is prioritized. If a disease of the kidney or adrenal gland is present, drug treatment is also initiated. Depending on the severity of the kidney damage, the prospects for recovery are individual.
Prevention
Hyperandrogenemia can be prevented only to a limited extent. Recommendations include abstaining from nicotine, learning stress management techniques, and ultimately, consistent treatment of conditions that contribute to affecting hormonal balance. Since fatty tissue can also produce male sex hormones, weight reduction and a low-fat diet are very important for overweight women. Accordingly, exercise can also help prevent hyperandrogenemia.
Follow-up
In the case of hyperandrogenemia, aftercare proves to be relatively difficult, and the affected person usually has only very limited options available. First and foremost, rapid and, above all, early detection and treatment of this disease must be carried out so that further complications or complaints can be prevented. The earlier the hyperandrogenemia is detected, the better the further course of this disease usually is. A doctor should be consulted at the first symptoms and complaints. However, the disease cannot always be treated, so that another method must be used to fulfill the desire for a child. In some cases, psychological treatment is also necessary to reduce or avoid depression or psychological upsets. The support of one’s family or friends is also very important. The treatment itself can be carried out by taking medication, whereby the affected person must pay attention to a correct dosage with a regular intake. In the case of interactions or side effects, a doctor must also be contacted first. In the case of a tumor, it must first be removed. After such a surgical procedure, the patient should rest and take care of his body.
This is what you can do yourself
Hyperandrogenemia is a hormonal disorder that the patient cannot treat herself. An exact diagnosis is necessary so that the doctor can create an individually tailored therapy and treatment plan. The patient’s cooperation in this process can have a very positive effect if she answers all questions honestly and shares observations. Once the diagnosis has been completed and the treatment plan has been drawn up, the patient can contribute a great deal to her recovery by adhering strictly to the treatment plan and coming to the doctor for regular check-ups. A trusting relationship with the doctor allows queries or joint adjustments to the therapy plan. In many patients, hyperandrogenemia leads to increased and severe acne formation. Although this is not dangerous for those affected, it is usually perceived as a major deficiency from a cosmetic point of view and leads to further discomfort. The patient can do much to improve acne symptoms through intensive and proper skin care, and can seek advice and guidance from a beautician. A regular visit to the beautician supports the good course of acne. If physical symptoms such as aggressiveness or restlessness occur under hyperandrogenemia, the patient can seek help in a sports and exercise program appropriate to her capabilities. Healthy patients find that endurance sports help them to better control their mood swings.
