High and Low Testosterone Levels in MenAndrogens are a group of hormones that play a role in male traits and reproductive activity. Present in both males and females, the principle androgens are testosterone and androstenedione. Androgens may be called "male hormones," but don't let the name fool you. Both men's and women's bodies androgen levels in men androgens, just in differing amounts. Andrgoen fact, androgens have more than actions in androgen levels in men, and they are present in higher amounts than estrogens.
Androgen | HealthyWomen
Androgens are a group of hormones that play a role in male traits and reproductive activity. Present in both males and females, the principle androgens are testosterone and androstenedione. Androgens may be called "male hormones," but don't let the name fool you. Both men's and women's bodies produce androgens, just in differing amounts.
In fact, androgens have more than actions in women, and they are present in higher amounts than estrogens. The principal androgens are testosterone and androstenedione. They are, of course, present in much higher levels in men and play an important role in male traits and reproductive activity. In a woman's body, one of the main purposes of androgens is to be converted into the female hormones called estrogens.
In women, androgens are produced in the ovaries, adrenal glands and fat cells. In fact, women may produce too much or too little of these hormones——disorders of androgen excess and deficiency are among the more common hormonal disorders in women.
In women, androgens play a key role in the hormonal cascade that kick-starts puberty, stimulating hair growth in the pubic and underarm areas. Additionally, these hormones are believed to regulate the function of many organs, including the reproductive tract, bone, kidneys, liver and muscle. In adult women, androgens are necessary for estrogen synthesis and have been shown to play a key role in the prevention of bone loss, as well as sexual desire and satisfaction.
Excess amounts of androgens can pose a problem, resulting in such "virilizing effects" as acne, hirsutism excess hair growth in "inappropriate" places, like the chin or upper lip and thinning of hair on the head balding. About 10 percent of women with high levels of a form of testosterone called "free" testosterone have polycystic ovary syndrome PCOS , characterized by irregular or absent menstrual periods, infertility, blood sugar disorders prediabetes and type 2 diabetes , and, in some cases, symptoms like acne and excess hair growth.
Most women with PCOS are overweight or obese, though a small percentage have a normal body weight. Left untreated, high levels of androgens, regardless of whether a woman has PCOS or not, are associated with serious health consequences, such as insulin resistance and diabetes, high cholesterol, high blood pressure and heart disease.
In addition to PCOS, other causes of high androgen levels called hyperandrogenism include congenital adrenal hyperplasia a genetic disorder affecting the adrenal glands that afflicts about one in 10, to one in 18, Americans, about half of whom are women and other adrenal abnormalities, and ovarian or adrenal tumors. Medications such as anabolic steroids, occasionally abused by body builders and other athletes for performance enhancement, can also cause hyperandrogenic symptoms.
Low androgen levels can be a problem as well, producing effects such as low libido interest in or desire for sex , fatigue, decreased sense of well-being and increased susceptibility to bone loss, osteoporosis and fractures. Because symptoms like flagging desire and general malaise have a variety of causes, androgen deficiency, like hyperandrogenism, often goes undiagnosed.
Low androgen levels may affect women at any age, but most commonly occur during the transition to menopause, or "perimenopause," a term used to describe the time before menopause usually two to eight years. Androgen levels begin dropping in a woman's 20s, and by the time she reaches menopause, have declined 50 percent or more from their peak as androgen production declines in the adrenal glands, and the mid-cycle ovarian androgen boost lessens or evaporates altogether.
Further declines in the decade following menopause indicate ever-decreasing ovarian function. For many women, the effects of this further androgen decline include aggravation of hot flashes and accelerated bone loss.
These effects may not become apparent until the women are in their late 50s or early 60s. Small studies find they are effective in boosting libido, energy and well-being in women with androgen deficiencies, as well as providing added protection against bone loss. One study showed some increased risks of breast and endometrial cancer, along with several other adverse effects, from one oral form of combined estrogen and testosterone, but these risks have not been demonstrated with other forms of treatment.
Testosterone is also an effective treatment for AIDS-related wasting and is undergoing studies for treating premenstrual syndrome PMS and autoimmune diseases.
Women with PMS may have below-normal levels of testosterone throughout the menstrual cycle, suggesting that a testosterone supplement may help, but such treatments have not been proven effective. Your androgen levels may be normal, too high hyperandrogenism or too low hypoandrogenism. A health care professional can assess whether your symptoms suggest abnormal levels and can order a blood test to measure hormone levels.
But results from blood tests are often misleading and may not be conclusive because there is no agreement on just what constitutes "normal" androgen levels in women. Plus, levels fluctuate depending on a woman's age, the timing of her menstrual cycle and her menopausal status.
Further, many standard laboratory tests, optimized for measuring testosterone in men, may not be sensitive enough to accurately measure women's levels.
As a result, it is easier to diagnose androgen levels that are too high, rather than levels that are too low. If you suspect you have a hyperandrogenic condition, it is important to seek a diagnosis and develop and begin a treatment plan. Hyperandrogenism can produce bothersome cosmetic symptoms like unwanted hair on your upper lip and chin.
Psychologically, the clinical manifestations of hyperandrogenemia persistent acne, excess facial or body hair, thinning of hair on the scalp and obesity can be devastating to young girls and women of reproductive age and may contribute to feelings of low self-esteem, anxiety, depression and antisocial behavior.
Women with excessive, uncomfortable sexual tension may also have high levels of androgens. Hyperandrogenic conditions are also associated with serious health problems like insulin resistance a precursor to diabetes , diabetes and heart disease. Hyperandrogenic syndromes often go undiagnosed, even though symptoms may be treated. For example, you may be treated for acne, without being evaluated for glucose tolerance or asked about menstrual regularity.
It may be up to you to tie together some of your hyperandrogenic symptoms and ask for a more integrated evaluation and treatment approach. If your symptoms include irregular or absent periods, you may have polycystic ovary syndrome PCOS ——the most common condition associated with hyperandrogenism.
The menstrual irregularity indicates infrequent or absent ovulation, making PCOS a leading cause of female infertility, which is often treatable. Some women with hyperandrogenism may experience spontaneous ovulation, and pregnancies may occur. However, women with high androgen levels also have an increased risk of miscarriage. Hyperandrogenic symptoms may also be caused by a genetic disease called congenital adrenal hyperplasia CAH. Severe cases can result in such extreme effects as genital malformation and virilization facial hair, acne at a young age.
Milder cases may look a lot like PCOS, with symptoms possibly including facial hair, irregular periods and high blood pressure. Women with mild CAH may also be shorter than their parents, vulnerable to infections and have a somewhat "masculine build," with square shoulders and narrow hips. A thorough medical history and physical examination provide the most important initial diagnostic information.
Laboratory tests usually serve to confirm the presence of hyperandrogenemia, a medical term meaning too much androgen in the blood. A blood test for total and free testosterone may be ordered, as well as a lipid profile to measure cholesterol levels , luteinizing hormone LH , follicle-stimulating hormone FSH , prolactin and a fasting glucose test.
Thyroid tests are usually included in the evaluation. Inflammation is also a component of PCOS, so a physician may choose to measure some inflammatory markers as well. Hormone therapy HT , which consists of either estrogen and progestin sometimes referred to as hormone replacement therapy, or HRT or estrogen-only therapy ET , and birth control pills containing estrogen, are other treatment options.
Oral estrogens boost levels of sex hormone binding globulin SHBG , a protein made in the liver that binds testosterone and estrogen. This reduces levels of free testosterone, which may be triggering symptoms. Glucocorticoids cortisone , which are often prescribed for asthma or inflammation, can also suppress production of androgens. Androgen levels in women peak during their 20s. Then a decline in daily production begins that continues throughout a woman's life. The only time a sudden drop-off in androgen levels occurs is in women who have their ovaries removed about half of all androgens are produced in a woman's adrenal glands and half in her ovaries.
By the time a woman reaches menopause, blood androgen levels are about half of what they were at their peak. Low androgen levels in women during their reproductive years, as well as following menopause, result in three noticeable symptoms: Low androgen levels also have been linked to bone loss and osteoporosis a disease that causes thin, fragile bones , possibly explaining the phenomenon of excessive bone loss in some women who go through ovarian failure or surgical removal of the ovaries.
Low sex drive and vaginal dryness are two common symptoms experienced by some women during the transition to menopause, making sex uncomfortable or painful. These changes have been related to low estrogen as well as low androgen levels. If you recognize any of the following changes, you should see your health care professional to discuss your concerns.
To diagnosis androgen deficiency, your health care professional will consider symptoms such as low libido and fatigue. Other conditions that can cause similar symptoms will also need to be ruled out. Blood tests for testosterone and SHBG will likely be part of your evaluation.
SHBG binds to testosterone, making it less available for influencing cellular actions. SHBG levels can vary dramatically in response to oral estrogen therapy following menopause or to oral contraceptives. In some women, SHBG changes are modest and have minimal effect on free androgen levels, while in others, it can increase greatly and give rise to lowered sex drive undesirable or reduced free testosterone and a resulting decrease in side effects such as acne and hirsutism desirable.
Blood testing for testosterone in hypoandrogenic women is problematic. Health care professionals have not reached a consensus about what constitutes low levels in women, and levels at the lower end of the female range are difficult to measure with many commercially available laboratory tests. For this reason, Endocrine Society Clinical Practice Guidelines recommend against making a formal diagnosis of androgen deficiency.
The causes of androgen deficiency are varied. The most common cause of low androgen is aging. If your symptoms bother you, you may want to talk to your health care professional about androgen replacement. You have Turner's syndrome, a genetic growth disorder that occurs in about one in 2, girls that arises when one, or part of one, of the two X chromosomes is missing two X's code for a female, an XY for a male.
This is a condition in which the ovaries fail to develop. Other conditions associated with low testosterone include hypothalamic amenorrhea absence of menstrual periods resulting from excessive dieting and exercising and hyperprolactinemia characterized by high levels of prolactin, the hormone that drives milk production when a woman breastfeeds.
Additionally, a variety of pituitary gland tumors are also associated with low production of testosterone, as well as other hormones. Sometimes there is no obvious cause of androgen deficiency. Otherwise healthy women of reproductive age can suffer from low androgens, which can be confirmed with blood tests and after other potential causes of low libido and fatigue are eliminated.
To exclude other potential causes of low libido and fatigue, your health care professional may ask you about past psychological or relationship problems and check for other potential causes of fatigue, such as depression, hypothyroidism and iron deficiency. Therapy with oral estrogens oral estradiol and conjugated estrogens conjugated equine estrogen or synthetic conjugated estrogens or esterified estrogens can be difficult because oral estrogens are metabolized to estrone, which can be difficult to measure, and conjugated and esterified estrogens are largely composed of estrogenic compounds not measured in commercially available hormone tests.
Transdermal estrogens patches, gels, injections, etc. Androgen disorders cannot be cured but they can be treated, usually with medication. If you are overweight, losing as little as 5 to 10 percent in body weight can restore fertility and decrease hirsutism in some women with androgen excess.
Treatment may also include oral contraceptives. Keep in mind if you are of reproductive age, the right oral contraceptive choice can reduce hyperandrogenic symptoms, while the wrong one can make them worse.
When you hear the term oral contraceptives or birth control pills, it most often refers to "combination pills"—pills that contain both estrogen and progestin. The estrogen used is almost always ethinyl estradiol in varying doses, but numerous progestins are used, also in varying doses.
The key is the type of progestin included. Some progestins can mimic androgens and make symptoms worse, but some avoid this problem, allowing the estrogen in birth control pills to raise levels of sex hormone binding globulin SHBG , reducing blood levels of free testosterone and improving symptoms.