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Ovarian overproduction of androgens

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

Causes

In healthy women, the ovaries and adrenal glands produce about 40% to 50% of the body's testosterone. Tumors of the ovaries and polycystic ovary syndrome (PCOS) can both cause too much androgen production.

Cushing disease is a problem with the pituitary gland that leads to excess amounts of corticosteroids. Corticosteroids may cause masculine body changes in women. Tumors in the adrenal glands can also cause too much production of androgens and can lead to male body characteristics in women.

Symptoms

High levels of androgens in a female can cause:

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

These changes may also occur:

  • Increase in the size of the clitoris
  • Deepening of the voice
  • Increase in muscle mass
  • Thinning hair and hair loss at the front of the scalp on both sides of the head

Exams and Tests

Your health care provider will perform a physical exam. Any blood and imaging tests ordered will depend on your symptoms, but may include:

  • 17-hydroxyprogesterone test
  • ACTH stimulation test (unusual)
  • Cholesterol blood tests
  • CT scan
  • DHEA blood test
  • Glucose test
  • Insulin test
  • Pelvic ultrasound
  • Prolactin test (if periods come less often or not at all)
  • Testosterone test (both free and total testosterone)
  • TSH test (if there is hair loss)

Treatment

Treatment depends on the problem that is causing the increased androgen production. Medicines can be given to decrease hair production in women with excess body hair, or to regulate menstrual cycles. In some cases, surgery may be needed to remove an ovarian or adrenal tumor.

Outlook (Prognosis)

Treatment success depends on the cause of excess androgen production. If the condition is caused by an ovarian tumor, surgery to remove the tumor may correct the problem. Most ovarian tumors are not cancerous (benign) and will not come back after they have been removed.

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

  • Careful monitoring
  • Weight loss
  • Dietary changes
  • Medicines
  • Regular vigorous exercise

Possible Complications

Infertility and complications during pregnancy may occur.

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

Prevention

Women who have polycystic ovary syndrome can reduce their chances of long-term complications by maintaining a normal weight through healthy diet and regular exercise.

Open References

References

Bulun SE. Physiology and pathology of the female reproductive axis. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 17.

Chen ZJ, Legro RS, Ehrmann DA, Wei D. Androgen excess disorders in women. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 124.

Huddleston HG, Quinn MM, Gibson M. Polycystic ovary syndrome and hirsutism. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics, 2-volume set. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 589.

Lobo RA. Androgen excess in women. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 38.

  • Overproductive ovaries

    Overproductive ovaries - illustration

    If the ovaries produce too much androgen (hormones such as testosterone), a woman may develop male characteristics. This ovarian imbalance can be caused by tumors in the ovaries or adrenal glands, or by polycystic ovarian syndrome. Hyperandrogenism may include growth of excess body and facial hair, acne, amenorrhea (loss of menstrual periods), and changes in body shape. Virilization can occur with ovarian and adrenal tumors and includes deepening of the voice, male pattern balding, and increased muscle mass.

    Overproductive ovaries

    illustration

  • Follicle development

    Follicle development - illustration

    Normal egg release from the ovaries, shown in stages of development.

    Follicle development

    illustration

  • Overproductive ovaries

    Overproductive ovaries - illustration

    If the ovaries produce too much androgen (hormones such as testosterone), a woman may develop male characteristics. This ovarian imbalance can be caused by tumors in the ovaries or adrenal glands, or by polycystic ovarian syndrome. Hyperandrogenism may include growth of excess body and facial hair, acne, amenorrhea (loss of menstrual periods), and changes in body shape. Virilization can occur with ovarian and adrenal tumors and includes deepening of the voice, male pattern balding, and increased muscle mass.

    Overproductive ovaries

    illustration

  • Follicle development

    Follicle development - illustration

    Normal egg release from the ovaries, shown in stages of development.

    Follicle development

    illustration

 

Review Date: 4/16/2024

Reviewed By: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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