Androgens are there both in men and women, in Men they are high amount compared to women, the ratio of androgen and oestrogen actually matters. Androgens are hormones which stimulate the hair follicle and sweat glands, as a result, hair growth in androgen-sensitive areas become more, also sweating increases.
A little increase in androgen in women can alter the ratio and gives rise symptoms like extra facial and body hair, increased sweating, acne, etc. Androgen can come two sources, Adrenal glands and Ovaries, for both we have treatment available.
What are the causes of high Androgens in women?
PCO remains the commonest cause followed by excess working Adrenal glands or androgen-secreting tumours from Adrenals and Ovaries. After menopause, oestrogen levels come down, androgens take upper hand and women in the post-menopausal state, can see features of high androgens.
Blood Androgens can go up if we are taking androgens as medicines, knowingly for some medical disorders or unknowingly.
There is another entity called HAIRAN syndrome, the composition of High Androgen, Insulin Resistance and Acanthosis Nigricans. Acanthosis Nigricans area blackish skin pigmentation in neck, axilla and groin.
What is Hirsutism?
Unwanted facial and body hair in women is called hirsutism. It is subjective diagnosis, if you thinks your body and facial hairs are more they are more.
Following picture tells the area we check for hirsutism, actually there are some grades we can see how significant the score is, but this is mainly helpful in research set up.
Common sites of Hirsutism are face, surrounding areola, in the tummy other than hands and legs.
What are the necessary investigations?
We need to check the androgen levels, we normally check free Testosterone, 17(OH)P, DHEA-S. A lot of people may not have excess blood androgens but they have symptoms of excess androgen, their hormone sensitivity is more, so even with normal blood androgen they have extra facial or body hair and acne.
Good news is that they do respond to anti-androgens. Other investigations remain
- Blood glucose levels
- Serum lipids
- Imaging of Adrenal and Ovaries.
What are the treatment options available for high androgen?
- Weight loss
This will reduce insulin resistance and thus high androgen. With a loss of 5% body weight, they show a 40% improvement in hirsutism.
- Anti-androgen Drugs
a. Oral contraceptive pills (OCP) – Regularizes menstrual cycles and has best results on hirsutism when combined with anti-androgens. The OCP containing cyproterone actetate (2mg) is preferred.
These are available in packs of 21/ 28 (Containing active ingredient for 21 days and placebo for the remaining 7 days). They are to be taken cyclically. Menstrual cycles will regularize with medication. A washout period of 3-4 months required before conception.
b. Spironolactone – Has weak anti-androgen properties. A dose of 50 – 200mg/day can be used. Can cause intermenstrual bleeding. This can be avoided when used with OCP.
c. Flutamide – Potent anti-androgen. Dose of 125mg/day.
d. Finasteride – As effective as cyproterone. Adequate contraception is mandatory and a compulsory washout period of 3 months after drug cessation is necessary before conception.