Masculinization or androgenization refers to physical male changes in a woman. These occur when there is an excess of male hormones (androgens) in a woman’s body.
What is masculinization (androgenization)?
Masculinization occurs in a woman who shows an increased effect of male hormones, androgens. In a man or boy, these hormones ensure that the primary and secondary sexual characteristics can form and develop. These include, for example, the testicles, the voice change and the increased hair on the body from puberty onwards. In addition, androgens ensure that more muscle mass is built up through protein formation. Women also normally produce these hormones in small amounts, but in the case of masculinization, increased levels are found in the blood. The symptoms are mainly manifested in the fact that increased hair growth occurs all over the body and the voice sounds much deeper.
Causes
There are different causes for masculinization to occur. In most cases, there is a disorder of hormone metabolism, in which mainly the male hormones are affected. In this case, for example, the androgens cannot be broken down or converted properly; there is an increase in the level of androgens in the blood. Another cause of increased production of male hormones can be a tumor in the adrenal cortex, which is responsible for producing the hormones, or in the ovaries. Hormone production is controlled by the pituitary gland, which in turn releases certain hormones. Thus, a tumor on the pituitary gland can also cause the adrenal cortex or the ovaries to produce more androgens, which then also leads to masculinization. A disorder of the enzymes and enzyme formation can also lead to masculinization; this can be congenital or occur later in the period up to puberty. If you are a woman who frequently takes hormone supplements, for example anabolic steroids, you may derive another cause of masculinization.
Symptoms, complaints and signs
Female androgenization is manifested primarily by physical characteristics. Depending on the intensity, these symptoms can vary and appear to different degrees. Frequently, there is visibly increased facial and body hair (hirsutism). In affected women, dark beard hairs initially grow on the face, which can become increasingly thicker. An upper lip beard often develops. Typically, no new hair grows on the face, but the existing soft downy hair gradually thickens. In addition, there may be increased breast hair. At the same time, affected women show pathological, increased hair loss of the scalp hair in typical male pattern hair loss (alopecia). Usually there is diffuse hair loss in the crown area in the form of receding hairline. Sometimes light patches appear at the back of the head. Due to the influence of male hormones, the skin condition deteriorates significantly. The sebaceous glands secrete more sebum. Therefore, pimples, abscesses and nodules form more frequently. Sometimes acne develops. Other possible physical symptoms of androgenization are an enlargement of the clitoris, a visible increase in muscle mass, a deepening voice, increasing involution of the breasts and disturbances of the menstrual cycle. In advanced disease, infertility may occur. Extremely rarely, androgenization is manifested psychologically by increased aggression or increased sex drive.
Diagnosis and course
If masculinization is suspected, the physician performs a detailed examination and questioning. In order to be able to find the exact cause, some laboratory tests must be done to determine the hormone balance. In this way, the concentration of the different hormones in the body can be determined. If there are some indications of a possible tumor in the area of the pituitary gland, ovaries or adrenal cortex, imaging examinations are necessary. Primarily, computed tomography scans and ultrasound scans are performed in the abdomen; magnetic resonance imaging is more commonly used to examine the pituitary gland because it is more accurate for finding the head.
When should you go to the doctor?
If abnormalities of the hormonal system are noticed in sexually mature girls or women, a control visit to a physician should be initiated. Disturbances of menstruation, peculiarities of libido as well as optical abnormalities should be clarified by a doctor. A strong hair growth in the area of the face or a beard growth are considered signs of a present disorder. If an upper lip beard develops, a medical examination should be initiated to clarify the cause. A visit to the doctor is also advisable in case of hair loss, hair growth in the area of the chest as well as discrepancies in the appearance of the skin. Increased development of pimples, abscesses and impure skin are indications that should be investigated. If severe receding hairline develops, it is also advisable to investigate the cause. Peculiarities of behavior, a masculine appearance or a particularly deep voice should be discussed with a doctor. If psychological problems occur or existing irregularities increase in intensity, the affected person needs help and support. An unfulfilled desire to have children, an enlarged clitoris and an unusually pronounced muscle mass on the body are also signs of a hormonal disorder. In order for a diagnosis to be made, medical tests are necessary, which are used to clarify the cause. If there is a regression and thus reduction of the breast that is not in accordance with age, the observations should be clarified by a gynecologist.
Treatment and therapy
The therapy of masculinization is often lengthy and can extend over several years. It is important not to interrupt treatment, otherwise the symptoms may recur. Thus, it requires a strong perseverance to achieve a success of the therapy. In order to start the right treatment, the exact cause of the masculinization must first be known. In the case of a tumor, for example, surgery is inevitable, as well as subsequent therapy. If, on the other hand, the cause of masculinization is a defect in the enzymes, hormone therapy is initiated in which the production of androgens is suppressed. The active ingredients are similar to those used in hormonal contraceptives. Depending on how pronounced the masculinization is, it can be alleviated without hormone therapy, for example, if there are signs on the skin. Permanent epilation or laser treatment can alleviate increased body hair; the roots of the hair are destroyed and hair growth gradually decreases over time.
Prevention
One can prevent masculinization only if the cause is found in the use of anabolic steroids. These androgenic preparations should no longer be taken so that masculinization does not progress. These are mainly anabolic steroids and doping agents, which ensure that muscle mass is built up more rapidly by the body.
Aftercare
Masculinization represents a strong psychological burden for female patients. Therefore, primary aftercare is provided in the form of psychotherapeutic sessions. The self-esteem of those affected should be stabilized and psychological disorders such as depression prevented. Sufferers often experience bullying or discrimination in their immediate environment. Psychotherapy can intervene in these cases and prevent resulting psychological damage. An appropriate way of dealing with the disease is also learned during psychological aftercare. Aftercare for androgenization is not limited to the patient alone. Relatives may also suffer from the change and feel overwhelmed. In that case, psychological counseling extends to them as well. At the psychotherapeutic facility, they have a point of contact where they can seek professional advice in this stressful situation. In the case of an affected woman, aftercare, in addition to psychotherapeutic approaches, also consists of consultation with a gynecologist. Androgenization cannot be completely cured, but only contained. Hormones are administered by the specialist to regulate the estrogen balance. As part of follow-up care, estrogen levels are monitored during regular blood draws. If an increased or lower dosage of hormones is required, the amount is adjusted accordingly during follow-up care.
You can do it yourself
In the therapy of masculinization, a distinction is made between causal and purely symptomatic treatment. The causal treatment aims to treat an underlying disease. This includes, for example, discontinuation of so-called anabolic steroids, such as those often used by female athletes. However, if the cause of the disease is a tumor, the masculinization will gradually disappear on its own if the therapy is successful. In many cases, the treatment of masculinization is a lengthy process, as the actual causes are often unknown. In the case of masculinization where too many androgens are produced in the affected female body, a special hormone therapy may be promising. However, taking hormone preparations, such as the contraceptive pill, is only a purely symptomatic therapy. This is because the problems recur when the hormones are discontinued. Without such hormone therapy, all the various symptoms must be treated. In case of significant acne, special skin care products and cleansing masks made of healing clay can be used. If the patient has increased body hair, techniques such as laser hair removal can be used. The treatment of masculinization is very lengthy and should be individualized to the symptoms of the affected person. Except for abstaining from anabolic steroids, affected women can do little themselves to treat any masculinization that occurs.
