Hyperandrogenism in women: understanding the imbalance and reclaiming your fertility
Hyperandrogenism is a hormonal imbalance that, while not a standalone pathology, can act as a precursor to significant systemic conditions and noticeably diminish a woman's quality of life. However, by addressing lifestyle factors, diagnosing underlying diseases, and utilizing modern medical procedures, it is possible to restore health, regain control over the menstrual cycle, and achieve a successful pregnancy.
In this article, we will explore the causes and symptoms of hyperandrogenism, explain its impact on ovulation and endometrial quality, and detail proven methods for treatment and fertility restoration.
What is testosterone and why is it necessary for the female body?
Contrary to popular belief, male hormones are vital for women. They serve as the foundation for estrogen synthesis and ensure the proper maturation of ovarian follicles. Androgens are responsible for maintaining libido, bone density, and muscle tone. They also play a key role in regulating emotional well-being, affecting concentration and cognitive functions. For a stable reproductive system, precise hormonal balance is critical, as any deviation can lead to systemic failures.
Production: 25% of the total mass is synthesized by the ovaries, 25% by the adrenal glands, and the remaining 50% is converted into hormones within fat tissue and the skin.
Normal levels: In reproductive-aged women, total testosterone typically ranges from 0.31 to 3.78 nmol/l. Both the total concentration and the level of "free" (biologically active) testosterone are of vital clinical importance.
Why androgen levels rise
Androgens are a group of steroid male sex hormones produced in both male and female bodies. In women, they are secreted by the ovaries and the adrenal cortex. Key types include:
Dihydrotestosterone (DHT): The most active form of the hormone, converted from testosterone directly in the tissues. It is primarily responsible for acne and unwanted body hair growth.
Androstenedione: A precursor hormone produced by the ovaries and adrenals, which the body later converts into testosterone and estrogens.
DHEA-sulfate (DHEA-S): Produced exclusively by the adrenal glands. Its level is the primary marker of how actively the adrenals are involved in creating an androgen excess.
17-OH progesterone: Technically a metabolic intermediate, but a sharp rise in this marker directly indicates genetic variations in adrenal function that impact fertility.
Hyperandrogenism is an endocrine disorder characterized by either excessively high androgen levels or increased tissue sensitivity to these hormones. The causes are multifaceted, and international classifications identify several key factors:
Polycystic ovary syndrome (PCOS): Statistically, this causes 70–80% of all endocrine-related infertility. PCOS disrupts the communication between the pituitary gland and the ovaries.
Non-classic congenital adrenal hyperplasia (NCAH): A genetic mutation of the 21-hydroxylase enzyme leads to an accumulation of 17-OH progesterone, which then transforms into testosterone.
Insulin resistance: High insulin levels suppress the liver's production of SHBG (sex hormone-binding globulin). As a result, the concentration of free testosterone spikes.
Ovarian or adrenal tumors: Hormone-active neoplasms can secrete testosterone independently of the body's natural regulatory mechanisms.
Obesity: Adipose tissue functions not just as an energy depot, but as a major endocrine organ that actively interferes with hormonal equilibrium.
How high testosterone impacts reproductive function
Excessive testosterone suppresses the female reproductive system by disrupting the delicate mechanism of follicle maturation. Normally, one follicle reaches 18–22 mm to release an egg; however, androgen excess causes follicles to "stall" at the 5–9 mm stage, preventing ovulation.
Furthermore, hyperandrogenism negatively affects the endometrium (the uterine lining). The imbalance prevents the lining from reaching the necessary structure for implantation, making it difficult for an embryo to attach or increasing the risk of early miscarriage. Even if pregnancy occurs, high androgens can interfere with placental formation and fetal nutrition.
Primary symptoms of high testosterone
Skin: Persistent acne, oily skin and scalp (seborrhea), and darkened skin patches (acanthosis nigricans).
Hirsutism: Growth of coarse hair in a male-pattern distribution (chin, chest, abdomen, and thighs).
Androgenetic alopecia: Thinning of hair on the head and loss of volume.
Menstrual cycle: Irregular periods, cycles exceeding 40 days, or a complete absence of menstruation (amenorrhea).
Fertility: Lack of ovulation and the presence of multiple small cysts in the ovaries detected via ultrasound.
Body changes: Weight gain specifically around the waist (abdominal obesity).
Emotional state: Mood swings, irritability, anxiety, and decreased stress tolerance.
Diagnostic methods
A comprehensive protocol is required for an accurate diagnosis:
Hormonal profiling: Testing for free and total testosterone, along with SHBG to calculate the free androgen index (FAI).
17-OH progesterone: Tested strictly on days 3–5 of the cycle to rule out adrenal causes.
Ultrasound: Evaluating ovarian volume (normal is under 10 cm³), follicle count, and checking for tumors or PCOS markers.
Physical exam: Assessing external markers like hirsutism, acne, and calculating BMI.
Fertility restoration strategies
Modern reproductive medicine focuses on treating the underlying cause:
Metabolic therapy: If insulin resistance is detected, insulin sensitizers (like metformin) help lower ovarian androgen production.
Ovulation induction: Utilizing selective estrogen receptor modulators or gonadotropins to trigger egg release.
Laparoscopic drilling: A surgical option for PCOS that reduces local androgen levels in the ovaries for 6–12 months.
Lifestyle modification: Lifestyle is a key factor affecting free androgen levels. Losing just 5–7% of visceral fat can lower free testosterone and restore natural cycles in 40% of women. A low-glycemic diet and regular exercise are essential first steps.
Surrogacy for severe cases of hyperandrogenism
In clinical practice, hyperandrogenism may be combined with other factors, such as uterine pathologies, making pregnancy impossible. Surrogacy becomes a vital tool in these cases, allowing a woman to become the biological mother of her child.
The FetusPlus platform offers a secure solution for this journey. Our service connects intended parents with screened surrogates and donors worldwide, ensuring protected communication and expert support to help you achieve a genetically related child safely and effectively.
Conclusion
Hyperandrogenism is a well-studied condition that responds well to correction through medical guidance and lifestyle changes. With the right strategy — whether through clinical treatment or assisted reproductive technologies—the dream of motherhood is within reach.
This material is for informational purposes only. Please consult with your physician when planning a pregnancy or choosing a treatment method.