Ovarian overproduction of androgens is a condition in which the female ovaries make too much testosterone. This leads to the development of male characteristics in a woman. Other hormones, called androgens, from other parts of the body can also cause the development of male characteristics in women.

In healthy women, the ovaries and adrenal glands produce about 40 - 50% of the body's testosterone. Both tumors of the ovaries and polycystic ovary syndrome (PCOS) can cause excess androgen production.

Cushing's disease, an abnormality in the pituitary gland, causes excess amounts of corticosteroids, which cause masculine body changes in women. Also, tumors in the adrenal glands can cause overproduction of androgens and lead to male body characteristics in women.

Hyperandrogenism:

• Acne
• Amenorrhea(absence of menstrual periods)
• Changes in female body contours
• Decrease in breast size
• Increase in body hair in a male pattern (hirsutism) such as on the face, chin, and abdomen
• Oily skin

Virilization:

• Clitoromegaly (enlargement of the clitoris)
• Deepening of the voice
• Increase in muscle mass
• Temporal balding (thinning hair and hair loss)

• 17-hydroxyprogesterone test
• ACTH test
• CT scan
• DHEA blood test
• Glucose test
• Insulin test
• Pelvic ultrasound
• Prolactin (if periods are infrequent or absent) test
• Testosterone test
• Total cholesterol test
• TSH test (if there is hair loss)

Treatment depends on the problem that is causing the increased androgen production. Medications can be given to decrease hair production in patients who have excess body hair (hirsutism) or to regulate menstrual cycles. In some cases, surgery may be necessary to remove an ovarian or adrenal tumor.

The success of the treatment depends on what caused the excess androgen production. If the condition is caused by an ovarian tumor, surgical removal of the tumor may correct the problem. Most ovarian tumors are not cancerous (benign), and will not come back after they've been removed.

In polycystic ovary syndrome, the following can reduce symptoms caused by increased androgen levels:

• Careful monitoring
• Dietary changes
• Medications
• Regular vigorous exercise

Infertility is a possible complication.

Women with polycystic ovary syndrome may be at increased risk for:

• Diabetes
• High blood pressure
• High cholesterol
• Obesity
• Uterine cancer

There is no known prevention. Maintaining a normal weight through healthy diet and regular exercise can reduce your chances of any long-term complications.

Lobo RA. Hyperandrogenism: physiology, etiology, differential diagnosis, management. In: Katz V, Lobo RA, Lentz G, Gershenson D, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 40.

Bulun SE, Adashi EY. The physiology and pathology of the female reproductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 16.

Polycystic ovary syndrome is a condition in which there is an imbalance of a woman's female sex hormones. This hormone imbalance may cause changes in the menstrual cycle, skin changes, small cysts in the ovaries, trouble getting pregnant, and other problems.

Polycystic ovaries; Polycystic ovary disease; Stein-Leventhal syndrome; Polyfollicular ovarian disease

Female sex hormones include estrogen and progesterone, as well as hormones called androgens. Androgens, often called "male hormones," are also present in women, but in different amounts.

Hormones help regulate the normal development of eggs in the ovaries during each menstrual cycle. Polycystic ovary syndrome is related to an imbalance in these female sex hormones. Too much androgen hormone is made, along with changes in other hormone levels.

It is not completely understood why or how the changes in the hormone levels occur.

Follicles are sacs within the ovaries that contain eggs. Normally, one or more eggs are released during each menstrual cycle. This is called ovulation. In polycystic ovary syndrome, the eggs in these follicles do not mature and are not released from the ovaries. Instead, they can form very small cysts in the ovary.

These changes can contribute to infertility. The other symptoms of this disorder are due to the hormone imbalances.

Women are usually diagnosed when in their 20s or 30s, but polycystic ovary syndrome may also affect teenage girls. The symptoms often begin when a girl's periods start. Women with this disorder often have a mother or sister who has symptoms similar to those of polycystic ovary syndrome.

Changes in the menstrual cycle:

• Absent periods, usually with a history of having one or more normal menstrual periods during puberty (secondary amenorrhea)
• Irregular menstrual periods, which may be more or less frequent, and may range from very light to very heavy

Development of male sex characteristics (virilization):

• Decreased breast size
• Deepening of the voice
• Enlargement of the clitoris
• Increased body hair on the chest, abdomen, and face, as well as around the nipples (called hirsutism)
• Thinning of the hair on the head, called male-pattern baldness

Other skin changes:

• Acne that gets worse
• Dark or thick skin markings and creases around the armpits, groin, neck, and breasts due to insulin sensitivity

During a pelvic examination, the health care provider may note an enlarged clitoris (very rare finding) and enlarged ovaries.

Diabetes, high blood pressure, and high cholesterol are common findings, as are weight gain and obesity.

Weight, body mass index (BMI), and abdominal circumference are helpful in determining risk factors.

Levels of different hormones that may be tested include:

• Estrogen levels
• FSH levels
• LH levels
• Male hormone (testosterone) levels
• 17-ketosteroids

Other blood tests that may be done include:

• Fasting glucoseand other tests for glucose intolerance and insulin resistance
• Lipidlevels
• Pregnancy test(serum HCG)
• Prolactin levels
• Thyroid function tests

Other tests may include:

• Vaginal ultrasound to look at the ovaries
• Pelvic laparoscopy to look more closely at, and possibly biopsy the ovaries

Losing weight (which can be difficult) has been shown to help with diabetes, high blood pressure, and high cholesterol. Even a weight loss of 5% of total body weight has been shown to help with the imbalance of hormones and also with infertility.

Medications used to treat the abnormal hormones and menstrual cycles of polycystic ovary syndrome include:

• Birth control pills or progesterone pills, to help make menstrual cycles more regular
• Metformin, a medication that increases the body's sensitivity to insulin, can improve the symptoms of PCOS and sometimes will cause the menstrual cycles to normalize. For some women, it can also help with weight loss.
• LH-releasing hormone (LHRH) analogs

Treatment with clomiphene citrate causes the egg to mature and be released. Sometimes women need this or other fertility drugs to get pregnant.

Medications or other treatments for abnormal hair growth include:

• Birth control pills. It may take several months to begin noticing a difference.
• Anti-androgen medications, such as spironolactone and flutamide may be tried if birth control pills do not work.
• Eflornithine cream may slow the growth of unwanted facial hair in women.
• Hair removal using laser and nonlaser light sources damages individual hair follicles so they do not grow back. This can be expensive and multiple treatments are needed. Laser removal can be combined with other medicines and hormones.

Glucophage (Metformin), a medication that makes cells more sensitive to insulin, may help make ovulation and menstrual cycles more regular, prevent type 2 diabetes, and add to weight loss when a diet is followed.

Pelvic laparoscopy to remove a section of the ovary or drill holes in the ovaries is sometimes done to treat the absence of ovulation (anovulation) and infertility. The effects are temporary.

Women who have this condition can get pregnant with the right surgical or medical treatments. Pregnancies are usually normal.

• Increased risk of endometrial cancer
• Infertility (early treatment of polycystic ovary disease can help prevent infertility or increase the chance of having a healthy pregnancy)
• Obesity-related (BMI over 30 and waist circumferance greater than 35) conditions, such as high blood pressure, heart problems, and diabetes
• Possible increased risk of breast cancer

Call for an appointment with your health care provider if you have symptoms of this disorder.

Bulun SE, Adashi EY. The physiology and pathology of the female reporductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 16.

Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician. 2009;79:671-676.

Lobo RA. Hyperandrogenism: Physiology, etiology, differential diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 40.

ACOG Practice Bulletin Number 108, October 2009. Accessed March 31, 2010.

The normal amount of body hair varies widely among women. Usually, a woman will only grow fine hair (peach fuzz) on her lips, chin, chest, abdomen, or back. When women grow coarse, dark hairs in these areas, the condition is called hirsutism. This pattern of hair growth is more typical of men.

Hypertrichosis; Hirsutism; Hair - excessive (women); Excessive hair in women; Hair - women - excessive or unwanted

All women normally produce low levels of male hormones (androgens). Unwanted hair growth (hirsutism) in women may occur when the body makes too much male hormone.

In most cases, the exact cause is never identified. It tends to run in families. In general, hirsutism is a harmless condition. But many women find it bothersome, or even embarrassing.

A common cause is polycystic ovarian syndrome(PCOS). Women with PCOS and other hormone conditions that cause unwanted hair growth may also have acne, problems with menstrual periods, trouble losing weight, a deeper voice similar to that of men, and diabetes. If these symptoms start suddenly, there may be a tumor that releases male hormones.

The following other causes of unwanted hair growth are rare:

• Tumor or cancer of the adrenal gland
• Tumor or cancer of the ovary
• Cushing's syndrome
• Congenital adrenal hyperplasia
• Hyperthecosis (a condition in which the ovaries produce too much male hormones)
• Medications (testosterone, danazol, anabolic steroids, glucocorticoids, cyclosporine, minoxidil, phenytoin)

Rarely a woman with hirsutism will have normal levels of male hormones, and the specific cause of the unwanted hair growth cannot be identified.

Hirsutism is generally a long-term problem. There are a number of ways to remove or treat unwanted hair. Some treatment effects last longer than others.

Weight loss in overweight women can reduce hair growth. Bleaching or lightening hair may make it less noticeable.

Temporary hair removal options include:

• Shaving does not cause more hair to grow, but the hair may look thicker.
• Plucking and waxing are fairly safe and are not expensive. However, they can be painful and there is a risk for scarring, swelling, and skin darkening.
• Chemicals may be used, but most have a bad odor.

Laser hair removal (electrolysis) uses electrical current to permanently damage individual hair follicles so they do not grow back. This method is expensive and multiple treatments are needed. Swelling, scarring, and redness of the skin may occur.

Call your doctor if:

• The hair grows rapidly.
• The hair growth is associated with male features such as acne, deepening voice, increased muscle mass, and decreased breast size.
• You are concerned that medication may be worsening unwanted hair growth.

Your doctor will perform a physical examination, including a pelvic examination if appropriate. The doctor will ask questions such as:

• Do other members of your family also have excessive amounts of hair?
• What medications are you taking?
• Have your periods been regular?
• Are you pregnant?
• Have you noticed other signs of excess male hormones such as increased muscle mass, deepening voice, acne, or decreased breast size?
• When did you first notice these symptoms?

Your doctor may measure different hormone levels if you have moderate or severe hirsutism or you have other symptoms:

• Testosterone
• Dihydroepiandrosterone sulfate (DHEA-S)
• Luteinizing hormone (LH)
• Follicle stimulating hormone (FSH)
• Prolactin
• 17-hydroxyprogesterone

If a tumor is suspected, x-ray tests such as a CT scan or ultrasound may be recommended.

Medications or other treatments your doctor may prescribe include:

• Birth control pills. It may take several months to begin noticing a difference.
• Anti-androgen medications such as spironolactone may be tried if birth control pills do not work. There is a risk of birth defects if you become pregnant while taking these medicines.
• Hair removal using laser and nonlaser light sources damage individual hair follicles so they do not grow back. This is expensive and multiple treatments are needed. You may get a topical (applied to the skin) medicine called eflomithine during these treatments.

Martin KA, Chang RJ, Shrmann DA, Ibanez L, Lobo RA, Rosenfield RL, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:1105-1120.

Lobo RA. Hyperandrogenism: Physiology, etiology, differential diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 40.