Hyperandrogenism means too much of the male hormone androgen is present. Hyperandogenism is a common endocrine problem in women and is seen in about 1-2/20 women (5-10%). 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 is the most commonly used clinical diagnostic criterion of hyperandrogenism. It is defined as excessive growth of terminal hair in women in a male-like pattern. The presence of hirsutism is usually determined by using a standardized scoring system of hair growth. Depending on the definition, hirsutism is present in up to 80% of patients with hyperandrogenism.
- Acne: A skin condition that occurs when your hair follicles become plugged with oil and dead skin cells.
- Androgenic alopecia: Diffuse thinning on all areas of the scalp.
- Virilization: the development of male sexual and physical characteristics in a woman (e.g., muscle bulk, body hair, and deep voice) in a women. This is a relatively uncommon feature of hyperandrogenism, and its presence often suggests an androgen-producing tumor. A thorough history and a focused clinical examination are extremely helpful in diagnostic evaluation of patients with suspected hyperandrogenism.
Other signs include: Alopecia - balding, Hidradenitis suppurativa, Polycystic ovarian syndrome; Oligomenorrhea - menstrual irregularities, Obesity; Infertility; Libido - increased sex drive, and Type 2 diabetes.
Laboratory tests for hyperandrogenism
Several aboratory tests in the patient's bloodc an be done on the patient with suspectyed hyperadrogenism 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 of 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.