Excess Androgens

Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.

Hyperandrogenism or androgen excess (AE) is a condition that refers to having above-average levels of androgens in the body.

It is the most common metabolic disorder prevalent in females but can occur in both genders.

This article will go through some facts about these hormones, their metabolism, and the effects of excess androgens in adult males and females. Read on to learn about the fantastic and intricate biochemistry.

In this article we shall cover the following areas:

• Excess androgen production
• What are they?
• What do they do?
• What causes Hyperandrogenism?
• Effects 
• Diagnosis 
• Summary

Excess Androgen Production

Having abnormally high levels of androgens leads to many conditions, including hair loss, infertility, and irregularities in sexual life.

In males, however, having high androgenic hormone levels might be beneficial to some extent, e.g., stimulating muscle growth and enhancing strength.

Hyperandrogenism refers to an excess of testosterone or testosterone-like hormones. It mainly affects women and has a prevalence of 5-10%.

It is often associated with other conditions like polycystic ovarian syndrome (PCOS). In fact, the majority of the patients with PCOS are also affected by androgenic hormonal excess. [1]

What are androgens?

Androgens are hormones produced by various tissues of your body that primarily function to develop and sustain male sexual characteristics.

They are often referred to as ‘male hormones’ in lay terms. Apart from sexual development, androgens perform a variety of roles ranging from muscle growth to red blood cell production.

Contrary to the typical belief, androgens also play vital functions in normal female physiology, such as maintaining fertility and muscle mass. [2]

The human body houses numerous channels and has vast connectivity systems. It uses many different messengers, and hormones are one of those messengers.

Hormones are chemical compounds that transmit various messages across the body. They travel via the blood vessels and reach every single tissue of the body.

The intricate hormonal system is regulated very tightly, and a slight imbalance in hormones often leads to many problems.

Your body usually produces several types of androgens. They include:

• Testosterone – is the principal androgen produced by the testes (males) and ovaries (females). Primary sexual development, e.g., penile and testicular growth, and male fertility, depends on normal levels of testosterone. Moreover, it is also responsible for the development of secondary sexual characteristics in men like beard growth, pubic hair growth, and deepening of the voice. It is found 20-25 times more in males than females, but it is essential for normal functioning in both genders.
• Dihydrotestosterone (DHT) – is a more potent version of testosterone synthesized by the enzyme 5-alpha reductase. DHT is crucial for male fetal development and the onset of puberty. In adults, high DHT levels often lead to male-pattern baldness and benign prostatic hyperplasia (BPH) or enlarged prostate. Moreover, it regulates the activity of sebaceous glands in the skin. Abnormal levels of DHT are associated with acne – a condition caused by overactive sebaceous glands.
• Dehydroepiandrosterone (DHEA) – DHEA is a precursor to several androgens. It is produced in the adrenal glands in males and females and can be potentially converted into testosterone or other androgens.

Androstenedione – is similar to DHEA and is utilized to enhance the production of testosterone, primarily in males. [2]

What do androgens do?

Androgens modulate various biochemical procedures in the body.

As already mentioned, they are essential for good health in men and women. Some physiological roles that androgen carries out include:

• Male fetal sexual development  
• Onset of puberty
• Adult sexual development
• Development of secondary sexual characteristics
• Muscle growth – this is one of the critical functions of androgens and is responsible for the masculine look in males. It is also the reason why androgen abuse is widely spread across the planet. Young athletes often take androgens in an attempt to increase muscle hypertrophy and masculine features.
• Bone development – testosterone is required for the normal development of bones and sustaining bone strength.
• Red blood cell production

Fertility and libido (sex drive) – balanced androgenic hormones are responsible for maintaining fertility and libido in males and females.

Disturbances in testosterone levels can dramatically decrease fertility and hamper your sex life.

The increase in libido is increasingly considered due to androgen effects on the brain. [1]

Androgen Metabolism

Understanding the metabolism of androgens makes it easier for us to comprehend different aspects of hyperandrogenism.

Androgens are synthesized in the adrenal glands in both males and females. In males, however, the majority of androgen (testosterone) is produced by the leydig cells in the testes.

The precursor for androgens and all other steroid hormones is cholesterol which is derived from fat. [2,3]

Testosterone has various fates. It can travel via the blood to different organs and produce effects such as bone growth or be transformed into other hormones, namely DHT and estrogen.

Being a fat-derived hormone, it has to be carried by a specialized protein called steroid hormone binding globulin (SHBG).

SHBG levels are often measured to assess problems like androgen excess and hypogonadism.

The enzyme that converts testosterone into estrogen is called aromatase and is found in the adrenal glands and testes. Contrary to cliché, this process also occurs in males. [3]

What Causes Hyperandrogenism?

Hormonal imbalances can have multiple causes. The disorders can originate primarily from the gland itself, e.g., abnormality in the adrenal glands and testes, or they can be caused due to a disease of another organ, i.e., ovaries, etc.

Some common causes of androgen excess in males and females include
Polycystic ovarian syndrome (PCOS) – as the name suggests, this disease is characterized by multiple cysts in the ovaries and impaired ovarian function.

Due to this ovarian dysfunction, the hypothalamus increases the secretion of GnRH (gonadotropin-releasing hormone), which in turn raises LH (luteinizing hormone).

Consequently, the body's androgen production is increased. Moreover, PCOS is associated with high insulin levels, and high insulin can also raise the production of androgens. [4]

Due to the raised LH and insulin, almost 80-90% of women with PCOS also have underlying androgen excess.

Resultantly, facial hair, acne, deepening of the voice, and menstrual irregularities are common in these women. [5]

• Ovarian tumors – benign (non-invasive) and malignant tumors (excess growth of cells) of the ovaries have the propensity to produce testosterone and other androgens.
• Adrenal Disorders – since adrenal glands produce a significant amount of androgens, problems linked to these glands can cause hyperandrogenism.

The most notable cause of androgen excess regarding the adrenal gland is congenital adrenal hyperplasia (CAH).

This disorder is characterized by a deficiency of enzymes involved in steroid synthesis.

A defect of the enzyme 21-beta hydroxylase most commonly causes increased sex hormones (androgens). Other conditions of the adrenal gland which might raise androgens include adrenal tumors. [6,7]

• Pituitary Conditions – pituitary is a pea-sized gland and is often called the master gland of the body. Abnormalities of the pituitary frequently disturb other hormonal axes, including the androgen axis. Some pituitary conditions that cause high androgen are Cushing syndrome (due to excess ACTH) and excessive growth hormone (GH) secretion (acromegaly). [8]
• Obesity – obesity is a well-known cause of high androgen levels in females. The high content of fat causes excessive production of androgens. However, this condition only occurs in females and not in males. In males, obesity is related to decreased testosterone and DHEA levels. [9]
• Genetics – many hormonal conditions have a genetic factor to them. If you have an immediate relative experiencing androgen excess, you might have a slightly increased chance of developing androgen excess.
• Medications and synthetic androgen use – last but not least, the infamous abuse of steroids by the athletic industry is one of the leading causes of androgen excess in males. This occurs mainly in young athletes aiming to get doped up or compete in physique contests. Taking synthetic anabolic steroids raises testosterone levels dramatically. The rise in androgens is directly proportional to the dose of steroids taken. Anabolic steroids are usually administered via injections, pills, or patches. [10]

Effects of Hyperandrogenism

Androgen excess, like many other metabolic conditions, has variable consequences.

It follows a more debilitating course in women as their normal androgen level range is narrower.

In men, androgen excess is frequently asymptomatic and may even be beneficial in terms of muscle growth and enhanced masculinity.

Having a complete picture of androgen physiology, we will look at how androgen excess affects men and women.

Excess in Men

You might think that high androgens (testosterone) should be all good as they will boost your muscles and masculinity.

Well, you’re not totally wrong. Moderately elevated levels of androgens in the body stimulate the growth of masculine features such as beard and bulky muscles.

Furthermore, the increased production of red blood cells and enhanced bone growth will increase strength and elevated stamina.

Lastly, relatively higher levels of testosterone in your blood will keep you lean, improve fertility (via increasing sperm count) and escalate your libido and overall sexual performance. [11]

While men experience less severe symptoms of androgen excess or, at times, no symptoms at all, there are some notable manifestation of having androgen excess in the body.

Having excessive amounts of testosterone or other androgens can be very debilitating at times. You might experience the following:

• Testicular atrophy – shrinking of testicles and decreased sperm count. This seems odd but the mechanism here is that excessive androgens turnoff the body’s signal for normal testosterone production.
• Aggression – men with high androgens are subjected to widespread temper issues. An interesting fact about testosterone is that it decreases trust. Lack of trust can itself cause several behavioral problems including anger issues. [12]
• Prostate enlargement – as described earlier, dihydrotestosterone, stimulates prostate growth. Enlarged prostate frequently blocks the outflow of urine and initiates other urinary problems like UTIs. Continuously raised DHT also leads to the development of prostate cancer.
• Heart and Liver disease – it is more common in men who use synthetic steroids
• Male-pattern baldness – also caused by DHT
• High blood pressure - this is sometimes referred to as hypertension
• Acne – synthetic steroid use, especially by teenagers, often warrants fulminant acne which can root life-long scars and serious infections.
• High levels of bad cholesterol - LDL (low-density lipoprotein) [12–14]

Excess in Females

Androgen excess is more problematic in women. It is intuitive as women have a narrow range of androgens that is needed for normal functioning.

High androgen levels in women are often responsible for many issues like reproductive, skin, and behavioral issues. Most commonly, they constitute of:

• PCOS – it can also be defined as a consequence of androgen excess. This condition along with imbalance in the sex hormones induce infertility in many females which is their main devastating concern when they present to a doctor.
• Irregular menstrual cycles - the gap between your periods isn't consistent
• Hirsutism – excessive growth of hair. Androgens promote hair growth on the face, armpits, and pubic area. Women often experience growth of facial hair and this is one of the earliest signs of androgen excess.
• Acne – as androgens promote the secretions of sebaceous glands, they promote acne.
• Decreased breast size – due to imbalance of sex hormones.
• Male-pattern baldness - this condition is called androgenic alopecia [1]

How is Hyperandrogenism Diagnosed?

For diagnosis, your doctor will take a detailed history about your symptoms along with your family history.

To confirm the diagnosis, you’ll get tested for hormone levels in your body. The hormone levels that tested frequently consist of:

• Testosterone
• DHT
• DHEA
• Progesterone
• LH
• FSH
• GnRH

Your doctor will then check your results and conclude a diagnosis of hyperandrogenism. [1,15]

Summary

Hyperandrogenism or androgen excess is a condition in which your body houses excess levels of androgens or ‘male-sex hormones.’

This condition primarily affects women of reproductive age (pre-menopausal women) and is associated with other conditions especially polycystic ovarian syndrome (PCOS).

While elevated androgen levels can help stimulate muscle growth and masculinity in men, excessive androgens are often problematic.

In men, high androgen levels present as aggression issues, infertility, and decreased libido. On the other hand, women experience hirsutism (excessive body hair growth), reduced fertility, and menstrual irregularities. 

References:

1. Androgen Excess: Practice Essentials, Pathophysiology, Epidemiology. Available at: https://emedicine.medscape.com/article/273153-overview. Accessed April 5, 2022.
2. McEwan IJ., Brinkmann AO. Androgen Physiology: Receptor and Metabolic Disorders. Endotext 2021.
3. Longcope C. Androgen Metabolism. The Global Library of Women’s Medicine 2009. Doi: 10.3843/GLOWM.10279.
4. King J. Polycystic Ovary Syndrome. Journal of Midwifery & Women’s Health. Available at: https://www.medscape.com/viewarticle/551015_2. Accessed April 6, 2022.
5. Franks S. Polycystic Ovary Syndrome. Http://DxDoiOrg/101056/NEJM199509283331307 2009;333(13):853–61. Doi: 10.1056/NEJM199509283331307.
6. Congenital adrenal hyperplasia - Symptoms and causes - Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/congenital-adrenal-hyperplasia/symptoms-causes/syc-20355205. Accessed April 6, 2022.
7. Hyperandrogenism | DermNet NZ. Available at: https://dermnetnz.org/topics/hyperandrogenism. Accessed April 6, 2022.
8. Hadiji M jemel., Kalthoum M., Kandara H., Mimita W., Nagi S. Acromegaly: Ominous Cause of Polycystic Ovary Syndrome | ARC Journal of Clinical Case Reports. ARC Journal of Clinical Case Reports. Available at: https://www.arcjournals.org/journal-of-clinical-case-reports/volume-5-issue-2/1. Accessed April 6, 2022.
9. Reinehr T., de Sousa G., Roth CL., Andler W. Androgens before and after Weight Loss in Obese Children. The Journal of Clinical Endocrinology & Metabolism 2005;90(10):5588–95. Doi: 10.1210/JC.2005-0438.
10. Anabolic Steroids DrugFacts | National Institute on Drug Abuse (NIDA). Available at: https://nida.nih.gov/publications/drugfacts/anabolic-steroids. Accessed April 6, 2022.
11. Testosterone — What It Does And Doesn’t Do - Harvard Health. Available at: https://www.health.harvard.edu/medications/testosterone--what-it-does-and-doesnt-do. Accessed April 6, 2022.
12. Silver J. Don’t Be Deceived: Testosterone Decreases Trust. Available at: https://www.jwatch.org/jp201006140000002/2010/06/14/dont-be-deceived-testosterone-decreases-trust. Accessed April 6, 2022.
13. What Are Androgens? How Excessive Levels Affect Men and Women - Health Guide. Available at: https://ro.co/health-guide/androgens-testosterone-explained/#what-happens-if-your-androgens-levels-are-too-high. Accessed April 6, 2022.
14. What are the side effects of anabolic steroid misuse? | National Institute on Drug Abuse (NIDA). Available at: https://nida.nih.gov/research-topics/anabolic-steroids
15. Yildiz BO. Diagnosis of hyperandrogenism: clinical criteria. Best Pract Res Clin Endocrinol Metab 2006;20(2):167–76. Doi: 10.1016/J.BEEM.2006.02.004.