Androgen

Hormones are chemical messengers that control various physiological functions in the body. Among these, androgens play a crucial role in regulating the development and maintenance of male characteristics. However, they also have significant roles in female health.

In this comprehensive guide, we’ll explore everything about androgens — what they are, how they function, what happens when levels are imbalanced, and how androgen-related disorders are diagnosed and managed. Whether you’re interested in hormone health, researching a medical condition, or simply curious, this guide will provide valuable insights.

What Are Androgens?

Androgens are a group of sex hormones that play a key role in male traits and reproductive activity. While they are commonly referred to as “male hormones,” androgens are also present in females in smaller quantities.

The most well-known androgen is testosterone, but other important androgens include:

• Dihydrotestosterone (DHT)

• Androstenedione

• Dehydroepiandrosterone (DHEA)

• Dehydroepiandrosterone sulfate (DHEA-S)

Functions of Androgens

In Males:

Androgens are vital for:

• Development of male reproductive organs (penis, testes)

• Growth of facial and body hair

• Voice deepening during puberty

• Muscle mass and strength

• Bone density maintenance

• Sperm production

• Libido (sex drive)

• Regulation of mood and energy levels

In Females:

Although present in lower amounts, androgens help:

• Maintain muscle and bone strength

• Support libido

• Precursor to estrogen production

• Regulate ovarian function

Sources of Androgens

Androgens are produced in different organs depending on gender:

• In males:

  • Testes: Primary site for testosterone production.

  • Adrenal glands: Produce DHEA and DHEA-S.

• In females:

  • Adrenal glands: Major source of androgens.

  • Ovaries: Produce small amounts of testosterone and androstenedione.

The Role of Testosterone

Testosterone is the principal androgen, with the highest biological activity. It regulates:

• Male sexual development

• Fertility

• Mood and cognitive function

• Fat distribution and muscle strength

In females, optimal testosterone levels help maintain sexual health and vitality.

What Is Dihydrotestosterone (DHT)?

DHT is a more potent form of testosterone, formed by the action of the enzyme 5-alpha-reductase. It has a stronger affinity for androgen receptors and is primarily responsible for:

• Male pattern baldness

• Prostate enlargement

• Development of male external genitalia in embryos

Androgen Receptors

Androgens act by binding to androgen receptors (AR) present in tissues such as:

• Skin

• Prostate

• Hair follicles

• Skeletal muscle

• Brain

The androgen-receptor complex activates specific genes, influencing growth and development.

Androgen Deficiency

In Men (Hypogonadism)

Androgen deficiency, particularly testosterone, is called male hypogonadism. It may be:

• Primary (testicular failure)

• Secondary (pituitary or hypothalamic dysfunction)

Symptoms:

• Low libido

• Erectile dysfunction

• Fatigue

• Loss of muscle mass

• Depression or irritability

• Infertility

• Decreased bone density

Causes:

• Aging (andropause)

• Testicular injury or surgery

• Chemotherapy or radiation

• Genetic disorders (Klinefelter syndrome)

• Chronic diseases (diabetes, HIV)

In Women

Androgen deficiency in women can lead to:

• Reduced libido

• Fatigue

• Mood swings

• Osteoporosis risk

It may occur during menopause, ovarian insufficiency, or adrenal dysfunction.

Androgen Excess

In Women

Excess androgen levels in females can cause a condition known as hyperandrogenism. Common conditions include:

1. Polycystic Ovary Syndrome (PCOS)

• Most common cause of high androgens

• Symptoms: Irregular periods, acne, hirsutism, infertility, weight gain

2. Congenital Adrenal Hyperplasia (CAH)

• Genetic disorder leading to excess adrenal androgen production

3. Androgen-secreting tumors

• Rare, but can produce rapid-onset symptoms

Symptoms of Androgen Excess in Women:

• Excess facial/body hair (hirsutism)

• Acne

• Oily skin

• Hair thinning or male-pattern baldness

• Menstrual irregularities

• Deepening of voice

• Increased muscle mass

In Men

Androgen excess in men is less common but may result from:

• Anabolic steroid use

• Testosterone replacement overdose

• Tumors

Diagnosis of Androgen Imbalance

1. Medical History and Physical Examination

Your doctor will evaluate:

• Symptoms

• Medical history

• Drug and supplement use

• Family history

2. Hormonal Blood Tests

Tests may include:

• Total and free testosterone

• DHEA-S

• DHT

• Luteinizing hormone (LH)

• Follicle-stimulating hormone (FSH)

• Estrogen

• Prolactin

• SHBG (sex hormone-binding globulin)

3. Imaging and Additional Tests

• Pelvic or abdominal ultrasound (for women with PCOS)

• MRI or CT scan (for adrenal/testicular tumors)

• DEXA scan for bone density in suspected low testosterone

Treatment of Androgen Deficiency

1. Testosterone Replacement Therapy (TRT)

For males with clinically low testosterone:

• Injections

• Gels

• Patches

• Implants

Benefits:

• Improved libido

• Better mood and energy

• Increased muscle mass

• Better bone density

Risks:

• Acne

• Sleep apnea

• Prostate enlargement

• Reduced sperm production

TRT is not recommended for men trying to conceive.

2. Lifestyle Modifications

• Regular exercise

• Adequate sleep

• Stress reduction

• Weight loss

• Avoid alcohol and smoking

Treatment of Androgen Excess in Women

1. Lifestyle Management

• Weight loss

• Exercise

• Low-glycemic diet (especially in PCOS)

2. Medications

a. Oral Contraceptives

• Regulate periods and reduce androgen production

b. Anti-Androgens

• Spironolactone: Blocks androgen effects

• Flutamide and bicalutamide (less commonly used)

c. Metformin

• Used in insulin-resistant PCOS to reduce androgen levels

d. Eflornithine Cream

• Slows facial hair growth

Androgen and Fertility

In Men:

• Low testosterone can impair sperm production

• TRT may suppress natural sperm production, leading to infertility

In Women:

• Androgen excess (as in PCOS) disrupts ovulation

• Can lead to difficulty in conceiving

Fertility treatments may include ovulation induction, IVF, or hormonal balancing.

Androgens and Skin Health

Androgens stimulate sebaceous glands, increasing oil production. High androgen levels are associated with:

• Acne vulgaris

• Oily skin

• Scalp hair thinning (androgenetic alopecia)

Dermatological treatments often involve hormonal therapy to control androgens.

Androgenic Alopecia (Male and Female Pattern Baldness)

A common result of increased sensitivity to DHT. Treatments include:

• Minoxidil (topical)

• Finasteride (oral DHT blocker for men)

• Low-level laser therapy

• Hair transplantation

Androgen Abuse: Anabolic Steroid Use

Some athletes misuse synthetic androgens (anabolic steroids) to enhance performance. Long-term misuse can lead to:

• Liver damage

• Cardiovascular disease

• Aggression or mood swings

• Infertility

• Gynecomastia in men

Steroid use without medical supervision is dangerous and illegal in many countries.

Androgens and Aging

As men age, testosterone levels gradually decline (~1% per year after age 30). This may result in:

• Decreased energy

• Loss of muscle and bone

• Erectile dysfunction

• Depression

Known as late-onset hypogonadism or andropause, this condition may be treated with careful hormone replacement therapy under medical supervision.

Androgens are vital hormones that impact nearly every aspect of physical and reproductive health in both men and women. From puberty to old age, androgens regulate sexual development, metabolism, mood, and body composition. However, imbalances in androgen levels—either too much or too little—can lead to a wide range of health issues.

If you’re experiencing symptoms related to androgen deficiency or excess, consult your healthcare provider. Early diagnosis, lifestyle management, and proper treatment can help restore hormonal balance and improve quality of life.