Androgens and Polycystic Ovary Syndrome: How Are They Related?
Polycystic ovary syndrome (PCOS) is considered to be an endocrinopathy. Therefore, it’s commonly associated with changes in reproductive hormones, including androgens.
In women, high levels of androgens commonly increase the risk of metabolic syndrome and cause hirsutism (an excessive growth of hair in areas where it doesn’t usually appear in great quantities).
In the long term, this same excess increases the risk of cardiovascular disorders, including high blood pressure and hyperlipidemia, both in women of normal weight and in women with obesity. For this reason, medical treatment is necessary.
But what are androgens?
What are androgens?
Dr. María Inés Martínez recalls that “although sex hormones are gender-typical, they aren’t gender-limited, both men and women use the same pathways, hormones and enzymes for their synthesis and metabolism.”
This means that, although androgens are considered male hormones, they’re also present in the woman’s body, only usually to a lesser extent. The same happens with estrogens – these are present in both sexes, but they tend to predominate more in women.
For their part, Malgor and Valsecia explain the following:
- Androgens – testosterone, androsterone, and androstenedione – are steroids derived from cyclopentaneperhydrophenanthrene.
- Testosterone is synthesized from cholesterol in the Leydig cells of the testes, the adrenal cortex, and the thecal cells of the ovary. This means that in men they’re secreted by the testicles and in women by the ovaries and the adrenal cortex, especially dihydroepiandrosterone.
In addition to testosterone and androsterone, the list of androgen hormones consists of androstenediol (A5), androstenedione (A4), dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), and dihydrotestosterone (DHT).
Roles in both sexes
- Androgens contribute to the balance of the body in both sexes. They’re key in normal reproductive function (sexual desire and response), but also in the growth and function of muscles, bones and fat mass, as they exert important metabolic effects on proteins, fats, and carbohydrates.
- Indirectly, they influence insulin sensitivity.
- They’re also key in cognitive function and, by extension, emotional well-being.
- In men, its main function is the development and maintenance of masculine characteristics.
- In women, androgens fulfill important functions related to metabolism and sexuality.
The influence on the female reproductive system
According to an article published in the Andalusian Journal of Sports Medicine, along with aromatase, androgens allow the ovaries to convert steroids into estrogens.
In healthy women, during ovulation, there’s an increase in the levels of androgens, but also of estrogens and progesterone. However, it’s in the luteal phase that estrogens and progesterone reach their highest levels.
What is hyperandrogenism?
As we’ve seen, although there are specific times in the menstrual cycle when androgen levels can increase, it’s more normal for them to subside, rather than them being maintained over time.
When a woman has consistently higher levels of androgens than they should have, it’s called hyperandrogenism. This excess can have several consequences, such as oily skin, acne, hirsutism, amenorrhea (absence of menstruation), and hypertension, among others.
Clinical signs of hyperandrogenism
Hyperandrogenism doesn’t always manifest itself in the same way, but varies from woman to woman. For this reason, some may experience certain symptoms and others may experience the most characteristic ones in a very noticeable way. Some of them would be the following.
“The action of testosterone, mediated by the corresponding enzyme (5α-reductase) on the pilosebaceous follicle, generates seborrhea and acne”, These last two are usually among the first cutaneous manifestations of hyperandrogenism in adolescents and young adults.
Virilization is characterized by the presence of a hoarse voice, breast atrophy, increased muscle mass, clitoromegaly (clitoral enlargement), and male pattern alopecia.
After the age of 20, it’s more common for abnormal hair growth to occur in areas where, in general, it shouldn’t be abundant (face, neck, breasts, back, abdomen-navel area, etc.). It’s called hirsutism, and it’s one of the clinical signs of high androgen levels.
As a consequence of hyperandrogenism, women can also experience alopecia or baldness with a male pattern. In some cases, this may be uniformly present in the crown area, while in others, there may be a receding frontal hairline.
Not all women who are diagnosed with PCOS have high levels of androgens. Therefore, in the diagnosis, this isn’t the only parameter that’s taken into account.
In order to confirm or rule out PCOS, in addition to conducting an interview and a complete physical examination (to help meet the Rotterdam criteria), it‘ll be necessary to request a blood test to check androgen levels.
Even when the signs are very evident, the analysis provides details that allow a better understanding of the patient’s health status.
If you consider that you have recently experienced changes in your appearance, you have gained weight, and you are concerned, then it’s best to go to see your doctor.