Virilization: Causes, Treatment & Help

Virilization refers to the tendency to masculinization in women as a clinical picture requiring treatment. Different gradations and degrees of severity are possible, but always there is a pathological expression of secondary male sexual characteristics due to hormonal imbalances. Virilization can be accompanied by a permanent restriction of the quality of life for those affected due to its high psychological burden.

What is virilization?

Virilization is typically associated with a pathological overproduction of male sex hormones, particularly testosterone, in women. Virilization is typically associated with pathologic overproduction of male sex hormones, particularly testosterone, in women. Even if the disease does not appear until adulthood, the excess of testosterone in the bloodstream leads to significant metabolic changes. In most cases, it is a rather insidious disease process that can even last for years and is not always noticed immediately by the affected women. Rather, it is family members or even third parties, such as work colleagues, who inform those affected of the symptoms of increasing masculinization. In the rare case of fulminant virilization, however, the masculinization symptoms appear within a few days or weeks. In these cases, the disease causes the uncontrolled release of larger amounts of testosterone. Since the external appearance of virilization is reversible, at least to a certain extent, therapy should be initiated immediately, especially in these cases. In chronic courses, on the other hand, the symptoms of the disease often cannot be completely reversed.

Causes

Various causes are possible for the pathologic expression of male secondary sexual characteristics in women. However, these causes always lead to an increase in male sex hormones in the bloodstream. The most important congenital, genetic causes of virilization include PCO syndrome and adrenogenital syndrome, AGS. In AGS, hormone production by the adrenal glands is disturbed; in PCO, hormone production by the ovaries is disturbed. If virilization occurs suddenly, apparently without any apparent cause, it is often due to a malignant tumor of the adrenal gland, resulting in an uncontrolled release of male sex hormones into the free bloodstream. Benign and malignant tumors of the ovaries, ovarian tumors, can also lead to excessive hormone production and thus to virilization symptoms. In this context, hyperthecosis ovarii should be mentioned as a very rare ovarian dysfunction, which, however, is typically associated with a strong autonomous production of testosterone. In addition, a variety of drugs may also be responsible for virilization, including anabolic steroids, rheumatoid drugs, and specifically phenytoin as an antiepileptic.

Diseases with this symptom

  • Adrenogenital syndrome
  • Hyperthecosis ovarii
  • PCO syndrome

Diagnosis and course

The diagnosis of virilization results, especially in pronounced cases, from the typical symptoms. Male hairiness, the so-called hirsutism, a deeper voice pitch, an unusually large clitoris, a permanent absence of menstruation, amenorrhea, as well as male body proportions in women are among the typical symptoms of virilization. In order to confirm the diagnosis, further examinations should be carried out in addition to a detailed personal and family history. At every sign of virilization, a gynecological examination is standard, including a blood test of the hormone status for male and female sex hormones. The hormones testosterone and dehydroepiandrosterone are particularly important for confirming the diagnosis. For women, the medical contact for any form of masculinization is the gynecologist; for advanced diagnostics, radiologists and endocrinologists should also be consulted later. Imaging procedures can be used to rule out androgen-secreting tumors on the ovaries or adrenal glands as the cause. If elevated levels of the hormone alphahydroxyprogesterone are found in the blood, this indicates the presence of adrenogenital syndrome, AGS.Polycystic ovary syndrome, PCO syndrome, can often be detected as the cause of virilization with a simple ultrasound examination of the ovaries. If diagnosed at an early stage, the prognosis for virilization is good, because causal therapy can then lead to rapid resolution of the symptoms of the disease. If left untreated, virilization can also be chronic over many years. If androgen-secreting tumors are not detected, the mortality rate in affected women is significantly increased.

Complications

Virilization has several causes, which can carry various complications. In general, the main complications in women are psychological. Due to the increased hair growth, this is usually ridiculed, whereupon this isolates itself from society. This can lead to depression in the affected person. This is characterized by severe anxiety and obsessive-compulsive disorders, which can aggravate the symptomatology. In addition, depressives usually suffer from alcohol or drug addiction. Increased alcohol consumption leads to fatty liver, which can progress to cirrhosis. In the worst case, suicide of the patient occurs due to the high psychological stress. Furthermore, virilization can occur in the context of adrenogenital syndrome (AGS). Further complications that may arise due to this disease are a disturbance of the menstrual cycle, which may even lead to infertility (infertility). In addition, there may be an increased loss of salts, which can lead to cardiac arrhythmias. In men, adrenogenital syndrome can lead to a reduction in the size of the testis (atrophy) and a reduction in sperm quality. A condition with similar complications is polycystic ovary syndrome (PCO). Here, too, there are cycle disturbances and hirsutism. In addition, affected individuals usually suffer from androgen-dependent hair loss (alopecia), and the condition is often associated with obesity and diabetes.

When should you see a doctor?

Virilization must be treated in any case. It occurs as a consequence of an underlying disease and must therefore be limited. Urgent treatment is necessary if virilization causes psychological discomfort or depression in the patient. In the worst case, suicidal thoughts may arise, which often require treatment in a clinic. In order to prevent depression, psychological treatment should also be given in the case of virilization. The patient should then see a doctor when more and more male symptoms and features appear on the body. This can be, for example, the absence of menstruation or increased hairiness. If these symptoms occur without any particular reason, an examination and treatment by a doctor is usually necessary in any case. In the first place, the general practitioner or the gynecologist can be consulted. A medical doctor should also be consulted if there is a change in the pitch of the voice. If virilization occurs after taking certain medications, these can be replaced or completely discontinued after consultation with a physician. However, a physician should always be consulted.

Treatment and therapy

Treatment and therapy of any form and degree of virilization must be based on the cause. If no clear cause can be found, which is rarely the case, then at least symptomatic treatment with female sex hormones is given to delay the progression of virilization symptoms. Autonomous androgen-secreting tumors of the ovaries or adrenal glands must be surgically removed immediately. After the operation, close monitoring of hormone levels is essential, as the tendency to recurrence is high with hormone-forming malignant tumors. The treatment of AGS and PCO is complex and lengthy. In the case of adrenogenital syndrome, AGS, medication usually has to be taken for the rest of the patient’s life. Polycystic ovary syndrome, PCO, is also not curable and requires at least periodic intake of female sex hormones. In PCO syndrome, both ovaries are typically covered with small cysts. The easiest way to treat virilization is if it is simply due to a drug side effect. The relevant preparations are then discontinued immediately and replaced by drugs with similar active ingredients.

Outlook and prognosis

Virilization represents a serious psychological symptom and can therefore lead to severe psychological problems and depression. In many cases, the patient’s quality of life decreases and social contacts are broken off. Due to the male body proportions and the growth of hair, there is usually a reduced self-esteem. The affected person feels ashamed in front of other people. Virilization can often be diagnosed quickly by a doctor. If a tumor is responsible for virilization, treatment is given immediately. The success of this treatment depends on the severity of the cancer. However, if virilization is detected early, it can be treated relatively well. In some cases, virilization leads to addictive behavior, so that alcohol dependence or dependence on other drugs develops. Likewise, in many cases, virilization results in infertility. If virilization does not result from a tumor, it can be stopped or completely halted by the addition of female hormones.

Prevention

No prevention is possible for the congenital forms of virilization, PCO and AGS. Only early diagnosis can help contain the severity of virilization. The complicated drug-hormonal treatments are not suitable for self-medication. Only some symptoms of the disease, such as male hair on the face or body, can also be treated by self-medication with epilation or shaving.

What you can do yourself

Virilization includes various symptoms: a pronounced hairiness according to male distribution pattern on legs, intimate area, upper lip and chest. Other mermals may include, in particular, a deeper voice due to an enlargement of the larynx, changes in the female menstrual cycle and an increase in muscle mass that is atypical for women. To combat excessive body hair, several cosmetic options are now available. One remedy is Vaniqa cream, which is used on the face and neck and chin, and suppresses unwanted hair growth. Laser treatments are another option. Other methods include waxing, shaving and epilation. In addition, there are technical devices for home use to get rid of annoying hair permanently. These are EPL devices that work by means of light pulses. Since those affected suffer primarily psychologically from their symptoms, psychotherapy is indicated to treat possible depression and improve self-esteem. Strategies can be developed to better cope with the symptoms. Unnatural muscle growth and an uncharacteristically deep voice for women can be treated by taking hormones. However, it is not advisable to administer hormones on one’s own. Cycle disorders can also be controlled by targeted hormone administration. Certain birth control pills exist for this purpose, which the gynecologist prescribes.