PCOS is one of the causes of high levels of androgens in women, which are also the defining symptom of this condition. In this article, we'll explain its symptoms and how they impact PCOS. We'll also cover what triggers higher levels of androgens, as well as how they impact physical health.
What are androgens?
Androgens are male sex hormones that can be found in both male and female bodies. Women naturally produce fewer androgens than men, with the average being one-tenth to one-twentieth of what a male body produces.
The female body produces hormones from a number of organs. They include the ovaries, where androgen is turned into estrogen.
There are a lot of misconceptions about androgens. People often think of these hormones as the “male” ones and use them for their effect on the sexual development of men. But androgens are produced and required by all bodies, regardless of sex, for reproductive development.
Hormones like androgens allow communication between different cells across your whole body. Cells with these types of receptors are found everywhere. Think of each hormone as a key and the receptors in your body as locks—together, they make things happen. Steroid hormones are made up of cholesterol, like androgens & estrogen.
“Androgens in women are produced from cholesterol in the adrenal gland and ovaries and can be generated in the muscle tissue. Alterations in hormone levels can result in many changes in a person's body and behavior ”
Here are the different types of androgens and these plays an important role in your body system:
1. Testosterone
Testosterone is the most well-known androgen, which develops secondary sex characteristics in males.
2. Adrenal androgens
Adrenal androgens are the primary group of androgens that function as weak steroids. These include DHEA(Dehydroepiandrosterone), DHEA-S(Dehydroepiandrosterone Sulfate), and androstenedione. DHEA is a hormone that can be produced or found in different places, like the brain and the ovaries. When it comes to the production of male hormones, their main sites are the adrenal glands and testes. Women also produce them in their ovaries.
3. Dihydrotestosterone (DHT)
Another well-known androgen is dihydrotestosterone (DHT). When you're in your 40's, the male growth hormone, DHT, is responsible for balding and prostate growth. It also makes your sebaceous glands active. This is actually a metabolite of testosterone that's produced in the skin and reproductive tissues.
What is the role of androgens in your body?
Androgens are hormones that play a key role in the hormone formation that triggers puberty. They also stimulate hair growth in the pubic and underarm areas. It regulates all sorts of things, including your bones, muscles, kidneys, and liver. Androgens support healthy hormone synthesis, sexual desire, and strong bones. Androgens hormones are also involved in other important functions. These include:
- They help your body build muscle.
- These are vital for the process of sperm production.
- The way it acts on the central nervous system can have an effect on male sexual behavior
- Sex hormones like estrogen and androgens stimulate the secretion of growth hormones at the time of puberty by increasing their production.
- When these hormones are triggered, they cause the growth of muscles, facial & armpit hair, a low voice, and aggressiveness.
- Parts of the male reproductive system are becoming mature, developing properly, and working properly. This includes things like the vas deferens, epididymis, seminal vesicles, urethra, and prostate gland.
Apart from reproductive health, this hormone is also linked with the body's metabolism, insulin sensitivity, and possibly its fat distribution. Androgens also have important effects on your bones, heart, and brain function.
What is a normal level of androgens?
Here are the normal ranges of androgen according to particular conditions.
- This is the amount of testosterone in your blood. Women are recommended to have between 6.0 and 86 nanograms per deciliter, which corresponds to reading between 186 and 876 nanograms per liter (ng/L). PCOS can lead to an increase in androgen.
- Normal androgen levels range from 0.7 to 3.6 pg/mL. If you have PCOS, your levels may be higher than usual.
- Levels in the normal range are between 0.7-3.1 ng/mL but if they're high, it could be PCOS.
- For women in their 20s, normal levels are usually around the 300s. For women in their 30s, they may be closer to 200.
Do androgen levels change during the menstrual cycle?
Hormones like progesterone and estrogen can change within the menstrual cycle. In studies of women with regular menstrual cycles, the average total testosterone levels peaked mid-cycle. One study shows a peak is found around the time of the luteinizing hormone spike before ovulation.
“With that being said, not everyone will show the same changes in their levels. The range of variation can be pretty significant, so it’s important to look into different factors that might be influencing hormone levels”
This is in contrast to androgen levels, which might have a small peak around ovulation too, but that hasn't been proven to be different from other times. Apparently, different types of measurements find different results. This study suggests that the total androgen peaks during the menstrual cycle may not have a noticeable effect.
What are the symptoms of higher levels of androgens?
Signs and symptoms of hyperandrogenism may include abnormal hair growth, acne, irregular periods, and so on. This is when females grow faint signs of what is usually seen in males.
1. Hirsutism
Sometimes high levels of androgens in women will experience hair growth below the neck, like on the chest or back. This is called Hirsutism and can be treated just like a woman would have to treat it if they have PCOS. About 50-80% of women with this condition have PCOS. However, not all people with PCOS experience this symptom.
Hair removal is a process many people go through and sometimes don't realize it's a symptom of a medical condition. You should always inform your doctor if you're noticing this.
2. Acne
In adulthood, mild acne is not considered abnormal. Moderate to severe acne is associated with high levels of androgens. If you have severe acne, be sure to see a doctor.
3. Irregular periods
High levels of male hormones have been associated with menstrual disorders in the lab setting, but not in healthy women. A study discovered that changes in testosterone levels are related to menstrual irregularities, even among women with the most irregular cycles. Even healthy women who say they don't have any health concerns seem to have hormonal irregularity.
4. Absent periods (amenorrhea)
PCOS may also lead to androgen syndrome, which is when a female has high levels of male hormones. A study found that 78% of women with PCOS had high levels of testosterone
If a person's androgens are higher than normal (hyperandrogenemia), they may have trouble with menstrual cycles and even stop menstruating.
5. Eggs are not released during the menstrual cycle
Androgens are hormones that help with male and female growth, hormone production, and reproduction. A lot of people think only men produce androgens, but women have them too. Androgens like testosterone, androsterone, and androstenedione are mainly found in the ovaries or testicles, and the adrenal glands which are less well known. Frequent exposure to high levels of hormones may prevent your ovaries from releasing eggs as they should.
6. Infertility
Many women with high levels of male hormones have a lot of problems, such as irregular periods or acne. Some also experience excess hair growth and oily skin. Hyperandrogenism can be caused by Polycystic Ovary Syndrome (PCOS) where the ovaries produce too many male hormones and stop ovulating regularly. This condition also tends to cause infertility.
Health conditions associated with high androgen levels
Here are some of the conditions or concerns that can be caused by high levels of androgens or hyperandrogenism.
1. PCOS
Hyperandrogenism is the most common symptom of PCOS in women. It's caused by a disruption to the normal ovarian or adrenal function that leads to the production of excess androgens. The first symptom of an overabundance of androgens in PCOS can be the impairment of ovarian function in the form of increased follicle development and low levels of large follicles.
2. Tumors on the adrenal glands and ovaries
Congenital Adrenal Hyperplasia or tumor on the adrenal gland is when you're lacking some key hormones which offer a range of symptoms. These conditions affect the production of hormones, most notably androgens. If a person's adrenal gland is damaged, it can also cause other issues like decreased production of other hormones as well.
“Androgen-secreting ovarian neoplasms(tumors) are rare ovarian tumors that cause hirsutism and virilization. These symptoms may also include severe alopecia, deepening of the voice, and clitoromegaly. Ovarian tumors are often small or undetectable”
3. Hyperprolactinemia
Hyperprolactinemia and PCOS can cause male hormone overproduction, but they can also lead to ovulation problems. While hyperandrogenism in PCOS could come from the ovaries or the adrenals, hyperprolactinemia sees a higher incidence due to increased production of androgens in women by the adrenal glands. These stimulate lactation, but they can also cause acne and hirsutism.
4. Cushing’s disease
Cushing's disease is caused by a buildup of cortisol, which is the stress hormone. It can be caused by overproduction or from taking medicine to control certain conditions. Oversupply may be caused by an endocrine imbalance in the gland from which your hormones are regulated. This growth may lead to high levels of a hormone that helps with cortisol production, which can increase androgen hormones.
What else do androgen levels affect?
Libido (e.g. sex drive) and androgen levels have a convoluted relationship. A decline in androgens, notable testosterone, is assumed to be the source of libido changes as people get older.
However, androgen and libido do not appear to have a dose-response relationship. To put it another way, persons with low androgen don't always have low libido, and people with high androgen don't always have a high libido. For instance, people with PCOS tend to have high androgen levels but not necessarily high libidos.
Furthermore, androgen hasn't been proven to help premenopausal women with low libido, though postmenopausal women may benefit from short-term androgen therapy. There isn't a lot of research on DHEA supplementation's safety.
Changes in androgen levels, rather than absolute androgen levels, may be more important.
However, because libido is influenced by a variety of circumstances, including our overall health and how we feel about our partner, it's understandable that there isn't a clear "dose-response" relationship between hormones and libido.
Takeaway
While many people think that androgens are just "male" sex hormones, they actually play an important role in puberty. They can also be essential to developing a body and libido. When androgen levels are out of whack, it can affect your energy or sex drive. Or, at worst, it can lead to diabetes. With a simple blood test, you can measure the level of androgens in women to figure out if you have tumors or other conditions that cause them. Your healthcare provider can then provide the right treatment.
References
- Testosterone levels peaked midcycle. PubMed. 1999. “Androgens and osteocalcin during the menstrual cycle”. https://pubmed.ncbi.nlm.nih.gov/10084581/
- LH spike before ovulation. PubMed.1974. “Ovarian and adrenal contribution to peripheral androgens during the menstrual cycle”. https://pubmed.ncbi.nlm.nih.gov/4278727/
- Androgen peaks during the menstrual cycle may not have a noticeable effect. PubMed. 2011. “Testosterone reference ranges in normally cycling healthy premenopausal women”. https://pubmed.ncbi.nlm.nih.gov/21771278/
- Testosterone levels are related to menstrual irregularities. PubMed. 2006. “Menstrual cycle irregularities are associated with testosterone levels in healthy premenopausal women”. https://pubmed.ncbi.nlm.nih.gov/17039468/
- 78% of women with PCOS had high levels of testosterone. PubMed. 2017. “Hyperandrogenemia in women with polycystic ovary syndrome: prevalence, characteristics, and association with body mass index”. https://pubmed.ncbi.nlm.nih.gov/28099123/
- Dose-response relationship. Wikipedia. https://en.wikipedia.org/wiki/Dose%E2%80%93response_relationship