Virilization: Description
Doctors speak of virilization when women develop male secondary sexual characteristics:
- Male hair such as beard hair, chest hair (hirsutism)
- Lower voice pitch
- Abnormally large clitoris (clitoral hypertrophy)
- Absence of menstruation (amenorrhea)
- Male body proportions
The reason for the masculinization of women is an increased production of male sex hormones (androgens such as testosterone). The reasons can be diseases of the adrenal glands, the ovaries or the use of certain medications.
Virilization: causes and possible diseases
The most important causes of virilization are
- Adrenal tumour: Sometimes virilization is caused by an adrenal tumour that produces male sex hormones (androgens).
- Adrenogenital syndrome (AGS): This adrenal disease is a congenital disorder of hormone production by the adrenal glands. The result is masculinization with voice change, absence of menstruation and – in classic AGS – masculinization of the external female genitalia that occurs in the womb.
- Ovarian tumor: An ovarian tumor that produces androgens can cause beard growth, a deep voice and other signs of masculinization.
- Hyperthecosis ovarii: This very rare dysfunction of the ovaries is associated with a pronounced production of androgens and a strong masculinization.
Virilization: When should you see a doctor?
If virilization occurs suddenly, you should definitely have it checked out by a doctor. It could be caused by a tumor of the adrenal glands or ovaries.
Virilization: What does the doctor do?
The doctor will first ask you in detail about your medical history (anamnesis). For example, it is important to know when and what signs of virilization you have noticed or whether you are taking medication. It is also interesting to know how your menstrual cycle works or whether your period has stopped. The following tests will help you to find the exact cause of virilization:
- Gynaecological examination: This is routine if there are signs of virilization in women.
- Blood tests: First, the testosterone level in the blood is measured. If it is normal, this rules out an androgen-producing tumour in the adrenal glands or ovaries as the cause of virilization. If the testosterone level is elevated, however, the concentration of another hormone (dehydroepiandrosterone) is determined: If this is also elevated, this indicates adrenal disease as the cause of virilization.
Further examinations are necessary if there is concrete suspicion. To find out whether adrenogenital syndrome (AGS) is the cause of virilization, for example, the hormone ACTH is administered as a test. If the blood level of the endogenous hormone alpha-hydroxyprogesterone then rises excessively, AGS is probably present.
If polycystic ovaries are suspected, other hormone levels in the blood are determined, for example LH and FSH.
How virilization can be treated
The focus is on treating the disease that is the cause of virilization. For example, androgen-producing tumors in the adrenal glands or ovaries are operated on.
If the masculinization is due to adrenogenital syndrome (AGS), medication usually has to be taken for the rest of the patient’s life. A masculinized external genitalia (enlarged clitoris, reduced vaginal entrance), as occurs in classic AGS from birth, is operated on at an early stage. Normal sexual intercourse and pregnancy are possible later on.
The treatment of PCO syndrome is very lengthy; depending on the patient’s needs and symptoms, various medications are administered.
