Hyperandrogenemia

Hyperandrogenemia is a health condition that means that the body (ovaries or adrenal glands) is producing too many androgen hormones. Androgens are a group of sex hormones which LEVY Health tests for including testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEA sulfate). Free Androgen Index, something else LEVY Health looks for, is a ratio of testosterone to sex hormone binding globulin (SHBG) and is used to determine if you have abnormal androgen levels. 

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Hyperandrogenemia is the most common hormonal imbalance in women struggling to conceive, so you’re not alone! If you have severe hyperandrogenemia, it means that your levels of androgen hormones are very high.

Impact of hyperandrogenemia on fertility

Having excess androgens in the body can impact ovulation. Some women with this condition may have a shorter menstrual cycle or a luteal phase defect. Others will have a longer cycle, infrequent ovulation, or may not ovulate at all. Without ovulation, it’s not possible to conceive because there is no egg waiting to be fertilized by sperm.

Potential causes of hyperandrogenemia

Hyperandrogenemia is often associated with polycystic ovary syndrome (PCOS). But PCOS is rarely the cause of severe hyperandrogenemia. Other possible reasons for elevated androgen hormone levels in the body include: 

• Tumors on the ovaries, adrenal or pituitary glands 
• Severe hyperprolactinemia 
• Hypothyroidism (underactive thyroid) 
• Nonclassic congenital adrenal hyperplasia (genetic conditions affecting the adrenal glands) 
• Cushing’s syndrome (a disorder where the adrenal glands produce too much of the stress hormone cortisol)
• Anabolic steroids 

Insulin resistance may also play a key role in the development of hyperandrogenemia.

Symptoms of hyperandrogenemia

Physical signs of hyperandrogenemia can start showing up in puberty. Symptoms include:

• Acne
• Hair loss
• Obesity
• Ovarian tumors
• Deeper voice
• Increased muscle mass
• Abnormal uterine bleeding
• Extra hair growth (hirsutism) on the face, neck, upper back, arms, legs, and chest
• Period disturbances, including amenorrhea (missed periods) or irregular periods

There’s a close connection between hyperandrogenemia and weight gain.

Diagnosis of hyperandrogenemia

Doctors diagnose hyperandrogenemia based on your symptoms and blood tests that measure levels of androgen hormones. You may also have a vaginal ultrasound to check for cysts on the ovaries, a symptom of PCOS, or ovarian tumors.

The ACTH test is another blood test used to diagnose adrenal gland disorders. It measures the level of adrenocorticotropic hormone (ACTH) in the blood (a hormone produced by the pituitary gland which regulates cortisol) and can help to find the cause of hormonal imbalances.

When androgen levels are severely elevated, doctors may order additional imaging tests to make a diagnosis, including an MRI scan or CT scan of the abdomen. 

If the cause for your high androgen levels can’t be found using these tests, you may be referred to a radiologist for an advanced blood test. During the test, blood is drawn from the arm and the adrenal and ovarian veins simultaneously to find the source of excess androgens.

Treatment to improve fertility

The treatment of hyperandrogenemia depends on what’s causing it. If it’s because of PCOS, doctors usually prescribe a combination estrogen-progestin birth control pill to restore balance to sex hormone levels, regulate the period, and help with symptoms. Usually, symptoms improve pretty quickly – within 3-4 months of starting the pill. Get another blood test after taking the pill for a few months to see if your reproductive hormones are back in balance. If so, you can stop taking the pill and start trying to conceive again. But keep in mind that the cycle can become irregular again and symptoms can return after stopping the pill.

Other treatment options include various medications and hormones that trigger ovulation. These include clomiphene or letrozole, which make the body produce the hormones FSH and LH. This often helps women conceive.

If severe hyperandrogenemia is due to insulin resistance, metformin is an effective medication that can improve the body’s response to insulin and reduce androgen levels. Additionally, a low dose of glucocorticoids (such as cortisone) can decrease the adrenal glands’ production of androgens, normalize the menstrual cycle, and help with fertility.

Certain lifestyle changes can also help. For women who are obese (BMI > 30) and have hyperandrogenemia, weight loss has been proven to decrease levels of androgens and reduce excess hair growth. A well-balanced diet can help regulate your hormone levels and menstrual cycle and improve your fertility.

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