A frequent reason for consultation, hyperandrogenism refers to an overproduction of male hormones in a woman. This is manifested by more or less marked signs of virilization.

In women, the ovaries and adrenal glands naturally produce testosterone, but in small amounts. It is usually found between 0,3 and 3 nanomoles per liter of blood, compared to 8,2 to 34,6 nmol / L in humans.

We speak of hyperandrogenism when the level of this hormone is higher than the norm. Signs of virilization may then appear: 

• hyperpilosité ;
• acne;
• baldness ;
• muscle hypertrophy, etc.

The impact is not only aesthetic. It can also be psychological and social. In addition, the overproduction of testosterone can lead to infertility and metabolism issues.

It can be explained by different causes, the most common being the following.

Ovarian dystrophy

This leading to polycystic ovary syndrome (PCOS). This affects around 1 in 10 women. Patients discover their pathology in adolescence, when they consult for a problem of hyperpilosity and severe acne, or later, when they are confronted with infertility. This is because the excess testosterone produced by the ovaries disrupts the development of the ovarian follicles, which do not mature enough to release their eggs. This is manifested by disorders of the menstrual cycle, or even by a lack of periods (amenorrhea).

Congenital adrenal hyperplasia

This rare genetic disease leads to adrenal dysfunction, including overproduction of male hormones and underproduction of cortisol, a hormone that plays a major role in the metabolism of carbohydrates, fats and proteins. In this case, hyperandrogenism is therefore accompanied by fatigue, hypoglycemia and a drop in blood pressure. This pathology usually manifests itself from birth, but in some more moderate cases it can wait until adulthood to reveal itself. 

A tumor on the adrenal gland

Quite rare, can lead to excessive secretion of male hormones, but also cortisol. Hyperandrogenism is then accompanied by hypercorticism, or Cushing’s syndrome, a source of arterial hypertension.

An ovarian tumor secreting male hormones

This cause is however rarer.

Menopause

As the production of female hormones is sharply reduced, male hormones have more room to express themselves. Sometimes this leads to deregulation, with significant signs of virilization. Only the clinical examination associated with a hormonal assessment, with dosage of androgens, can confirm the diagnosis. An ultrasound of the ovaries or adrenal glands may also be ordered to clarify the cause.

The clinical signs suggestive of hyperandrogenism are as follows:

• hirsutism : hair is important. In particular, hairs appear in areas of the body that are usually hairless in women (the face, torso, stomach, lower back, buttocks, inner thighs), which can have a significant psychological and social impact. ;
• acne et the seborrhée (oily skin) ; 
• alopecia male pattern baldness, with more marked hair loss at the top of the head or frontal globes.

These symptoms can also be associated with:

• menstrual cycle disorders, with either an absence of periods (amenorrhea), or long and irregular cycles (spaniomenorrhea);
• clitoral enlargement (clitoromegaly) and increased libido;
• other signs of virilization : the voice can become more serious and the musculature recall the male morphology.

When it is very marked, hyperandrogenism can lead to other long-term complications:

• metabolic complications : the overproduction of male hormones promotes weight gain and the development of insulin resistance, hence the risk of obesity, diabetes and cardiovascular disease;
• gynecological complications, including an increased risk of endometrial cancer.

This is why hyperandrogenism should not be considered only from a cosmetic point of view. It may require medical attention.

Management depends first of all on the cause.

In case of tumor

Surgery is required to remove it.

For polycystic ovary syndrome

There is no treatment to prevent or cure this syndrome, only treatments for its symptoms.

• If the patient does not or more children, the treatment consists in putting the ovaries to rest, to decrease their production of male hormones. An estrogen-progestin pill is prescribed. If this is not enough, an anti-androgen drug can be offered as a supplement, cyproterone acetate (Androcur®). However, since this product has recently been associated with a risk of meningioma, its use is restricted to the most severe cases, for which the benefit / risk ratio is positive;
• In case of desire for pregnancy and infertility, simple stimulation of ovulation is recommended by first-line clomiphene citrate. An infertility assessment is performed to verify the absence of other factors involved. If drug stimulation does not work, or if other factors of infertility are found, intrauterine insemination or in vitro fertilization is considered. 

Laser hair removal may also be offered to reduce hair growth and local dermatological treatments against acne.

In all cases, the practice of a sport and the follow-up of a balanced diet are advised. In case of overweight, a loss of about 10% of the initial weight reduces hyperandrogenism and all its complications. 

In case of adrenal hyperplasia

When the disease is genetic, specific care is put in place in centers that are experts in rare diseases. Treatment includes corticosteroids in particular.