Hyperandrogenism is a common endocrine problem in women and is seen in about 1-2/20 women (5-10%). Hyperandrogenism means too much of the male hormone androgen is present. Polycystic ovary syndrome (PCOS) is diagnosed in the majority of women who have hyperandrogenism.
Diagnosis of hyperandrogenism includes several tests including a pelvic exam, observation of clinical manifestations, and a blood test measuring androgen levels.
Clinical manifestations of hyperandrogenism
Hirsutism: This is the most commonly used clinical diagnostic criterion of hyperandrogenism. It’s defined as the excessive growth of terminal hair in women in a male-like pattern.
Acne: This occurs when your hair follicles become clogged with oil and dead skin cells.
Androgenic alopecia: Scattered thinning of the hair on all areas of the scalp.
Virilization: The development of male sexual and physical characteristics, such as muscle bulk, body hair, and a deep voice. This is a relatively uncommon feature of hyperandrogenism, and its presence often suggests an androgen-producing tumor.
Other signs include balding, menstrual irregularities, obesity, infertility, increased sex drive, and Type 2 diabetes.
Laboratory tests for hyperandrogenism
Several laboratory tests in the patient's blood can be done on the patient with suspected hyperandrogenism to evaluate levels of:
- FSH - Follicle-stimulating hormone
- LH - Luteinizing hormone
- DHEA-S Dehydroepiandrosterone sulfate
- 17OHP - 17 hydroxyprogesterone
- total and free testosterone
Abnormally high levels of any of these hormones help in diagnosing hyperandrogenism. A finding of 17OHP >10 ng/mL indicates the existence of a 21-hydroxylase deficiency, whereas values between 2 and 10 ng/mL suggest the need for further testing with adrenocorticotropic hormone stimulus. Elevated AMH values (>4.5 ng/mL) may be useful as a substitute for ovarian morphology when no accurate ovarian ultrasound is available.