Hyperandrogenism – also known as hyperandrogenemia – is a condition that is characterized by high testosterone levels. The majority of cases of high testosterone in women result from polycystic ovary syndrome (PCOS).
Have you been diagnosed with PCOS and hyperandrogenism? If so, then you’ve come to the right place. Here we go over everything you need to know about hyperandrogenism and how to manage it.
Symptoms of Hyperandrogenism and PCOS
Sometimes referred to as polycystic ovarian syndrome, PCOS is a condition that affects the endocrine system and reproductive system in women. PCOS affects millions of American women of childbearing age and causes excess androgen production and abnormally high androgen levels. Normally, females produce a small amount of testosterone, which plays a role in regulating mood, sex drive, and energy levels. However, androgen excess disrupts normal hormonal functioning and causes a myriad of symptoms.
Testosterone can be produced in the ovaries (ovarian androgen) or adrenal glands (adrenal androgen). PCOS is specifically characterized by ovarian hyperandrogenism. (1)
Symptoms of high testosterone and PCOS include:
- Hirsutism: Hirsutism describes a male pattern of hair growth that affects women with hyperandrogenism. Women may notice the growth of coarse hair on their chin, jaw, cheeks, and chest.
- Irregular menstrual cycles: Women with PCOS tend to have abnormal menstrual cycles. Some women may have no period at all, while others may have irregular periods.
- Infertility: Women with PCOS who are trying to conceive may have trouble getting pregnant. This is because PCOS causes imbalances in sex hormone levels, leading to anovulation. The probability of conceiving decreases without regular ovulation. Healthy ovulatory function requires balanced levels of testosterone, estrogen, and progesterone.
- Acne: Many women with hyperandrogenism and PCOS develop acne on the jawline and lower cheeks.
Because the endocrine system and metabolism and intertwined, metabolic abnormalities commonly co-occur with PCOS. Women with PCOS are often affected by:
- Hyperinsulinemia: Hyperinsulinemia causes an excess of insulin to be present in the blood. This can also be associated with skin disorders like acanthosis nigricans.
- Insulin resistance: Insulin resistance occurs when insulin does not work properly and the body doesn’t react to the presence of insulin in the bloodstream. As a result, cells do not uptake sugar from the blood, contributing to high blood sugar levels.
- Type 2 diabetes: Consistently high blood sugar levels and insulin resistance contribute to type 2 diabetes.
- Obesity: Hormonal imbalances and metabolic dysfunction combined with a diet high in calories, sugar, and fat cause excess weight gain.
- Hair loss: Also called androgenic alopecia, hair loss and baldness is a symptom of hormonal imbalances and hyperandrogenism in women with PCOS.
There are a series of diagnostic criteria that your physician will evaluate when determining if you have PCOS.
Your physician will discuss any symptoms you may be experiencing, such as irregular periods and hirsutism. If you have been trying to get pregnant for a long time without success, this may also be a clue to the presence of PCOS. These outward signs of hyperandrogenism are valuable diagnostic tools.
An ultrasound may reveal the presence of cysts on the ovaries, or numerous immature follicles. However, not all women with PCOS will have polycystic ovaries. Your physician may order ultrasound imaging tests to gain a better understanding of how your reproductive organs are functioning. Other follicular abnormalities may be present and ovaries may be enlarged with PCOS and hyperandrogenism.
Biochemical markers of PCOS are valuable tools in diagnosing PCOS. Your physician may look for:
- Androstenedione: Androstenedione is an androgen in the body that is found at elevated levels in women with PCOS.
- Sex-hormone-binding globulin (SHBG): SHBG is a hormone in the blood that binds testosterone. Physicians may test your SHBG levels if PCOS is suspected. In individuals with PCOS and hyperandrogenism, SHBG tends to be lower than normal.
- Free testosterone: Free testosterone is testosterone particles that are not bound to other compounds. Hyperandrogenic women with PCOS usually have elevated levels of free testosterone in the blood, which is linked to low levels of SHBG.
- DHEA-S: Dehydroepiandrosterone sulfate (DHEA-S) is an adrenal androgen. Levels of DHEA-S may be higher than normal among women with PCOS.
- Luteinizing hormone: Luteinizing hormone is responsible for triggering ovulation. In women with PCOS, luteinizing hormone levels may be a little higher than normal.
- Follicle-stimulating hormone: Follicle-stimulating hormone (FSH) is responsible for encouraging the growth and maturation of an ovarian follicle before it releases an egg.
Other Causes of Hyperandrogenism
Always make sure that your condition is diagnosed by a doctor. Only a physician can diagnose a hormonal disorder. It’s also important to keep in mind that PCOS is not the only cause of hyperandrogenism, and certain conditions may masquerade as PCOS. High testosterone levels may also arise as a result of conditions like:
- Congenital adrenal hyperplasia: Congenital adrenal hyperplasia (CAH) is a condition that a person is born with. Individuals with CAH produce insufficient levels of 21-hydroxylase, causing the adrenal glands to produce an excess of androgens. Physicians test infants’ 17-hydroxyprogesterone levels to determine the presence of 21-hydroxylase deficiency. Nonclassic 21-hydroxylase deficiency is another form of congenital adrenal hyperplasia that is undetectable at birth, but surfaces in adulthood. Individuals with nonclassic congenital adrenal hyperplasia may also have hyperandrogenism.
- Thyroid conditions: Certain thyroid conditions like hypothyroidism may be confused with PCOS. Women with hypothyroidism tend to exhibit similar symptoms, like hirsutism and irregular menstrual cycles. Hyperthyroidism may also be co-occurring with PCOS and worsen hyperandrogenism.
- Pituitary conditions: Pituitary conditions like Cushing’s disease may also be a cause of hyperandrogenism, though only in rare cases. Cushing’s disease develops when a tumor grows on the pituitary gland and results in excess secretion of adrenocorticotropic hormone (ACTH).
Treating Hyperandrogenism in PCOS
Hyperandrogenism and PCOS can seriously impact your quality of life. However, these conditions can be managed to improve your health and wellness. Are you wondering how to lower androgen levels in females naturally? Here are a few natural interventions that can manage and reverse hyperandrogenism and PCOS.
1. Eat an Anti-Inflammatory Diet
Eating an anti-inflammatory diet can help you manage PCOS and hyperandrogenism. An anti-inflammatory diet should include a variety of whole foods like fruits, vegetables, whole grains, nuts, seeds, beans, lean meats, low-fat dairy, and fish. An anti-inflammatory diet can help lower inflammation in the body, helping to normalize hormone levels and metabolic functions. Here are a few examples of foods to add to your diet:
- Fruits and vegetables: Fruits and veggies are chock-full of nutrients like vitamins, minerals, and antioxidants. Eating plenty of fruits and veggies is crucial for managing inflammation and hyperandrogenism. Plus, fruits and vegetables are nutrient-dense without being dense in calories. As a result, you can eat a higher volume of fruits and vegetables without overdoing your calorie intake. Choose foods like broccoli, kale, spinach, beets, bell peppers, Brussels sprouts, apples, oranges, strawberries, and blueberries.
- Whole grains: Whole grains are packed with fiber, minerals, and complex carbohydrates. Eating plenty of dietary fiber helps balance your microbiome and simultaneously reduce systemic inflammation. Reach for foods like quinoa, whole-grain bread, brown rice, oats, and millet.
- Nuts and seeds: Nuts and seeds are rich in healthy polyunsaturated and monounsaturated fats that can reduce inflammation. In particular, certain nuts and seeds are high in the plant form of omega-3 fatty acids or alpha-linolenic acid (ALA), which helps lower inflammation and balance hormones. Choose nuts and seeds like chia seeds, flaxseed, almonds, walnuts, pecans, and pistachios.
- Lean meats and low-fat dairy: Lean meats and low-fat dairy are excellent sources of protein and offer optimal ratios of essential amino acids. Choose foods like chicken breast, turkey breast, and nonfat yogurt.
- Fish: Fish is a rich source of animal forms of omega-3 fatty acids, called eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Fatty fish like salmon and mackerel provide these omega-3 fatty acids.
At the same time, it’s also important to eliminate certain foods from your diet when striving to reverse hyperandrogenism. Here are a few examples of foods to avoid:
2. Eating a High Protein Diet
Eating a high-protein diet is crucial for women with hyperandrogenism and PCOS. Protein provides amino acids, which are the smallest components of protein. Essential amino acids are nutritionally required on a daily basis because the body is unable to produce them internally.
Research shows that women with PCOS have imbalance levels of essential amino acids. (2) Moreover, a pilot study conducted in Italy evaluated the effect of essential amino acid supplementation on women with PCOS. (3) Results revealed that essential amino acid supplementation was associated with lower insulin levels and lower testosterone levels. (3)
Plus, the body digests protein slowly, which helps keep you fuller for longer. In this way, protein can serve as a weight loss aid.
So, how can you make sure that you’re getting the essential amino acids that you need? Lean meats, low-fat dairy, and fatty fish are excellent sources of essential amino acids. If you follow a plant-based diet and you don’t eat a variety of vegetable proteins on a daily basis, it may be a good idea to add a high-quality supplement to your routine.
3. Weight Loss
Weight loss on its own is linked to a mitigation of PCOS and hyperandrogenism symptoms. To encourage weight loss, eating a balanced diet and exercising regularly are important. Limiting your calorie intake to fit your age and activity level is also crucial for reaching a healthy weight.
Visiting Your Doctor
PCOS is usually treated by specialists in gynecology and obstetrics as well as endocrinology. Depending on your specific symptoms and needs, you may also be treated by specialists in dermatology for conditions like acanthosis nigricans. It’s always a good idea to discuss your dietary regimen and supplements with your doctor, to make sure you’re taking the steps to best support your health.
There are several medications that your doctor may prescribe to help manage hyperandrogenism and other PCOS symptoms.
- Metformin: Metformin is a medication that helps reduce systemic inflammation while also treating the metabolic abnormalities associated with PCOS, like hyperinsulinemia.
- Oral contraceptives: Oral contraceptives or birth control pills usually contain estrogen and progesterone and are effective in regulating the menstrual cycle. Birth control also helps treat virilization, which is the development of male characteristics like excess hair growth.
- Clomiphene: Clomiphene is useful in treating infertility in women with hyperandrogenism and PCOS. Clomiphene encourages ovulation, which increases the chances of getting pregnant.
Hyperandrogenism associated with PCOS is most common among premenopausal women of childbearing age. PCOS has a high prevalence rate among women in the United States. Luckily, there are steps you can take to manage hyperandrogenism and PCOS, including diet changes and certain medications. Hyperandrogenism usually results from PCOS, though it may also be a result of thyroid and pituitary conditions.