Women also have androgens As we all know, full breasts, slim body shape and clear voice is the unique secondary sex characteristics of women after puberty, which is a large number of estrogen and progesterone in the female body of the joint action of the results. However, we often overlook the small amount of androgens in the female body, which also play a significant role. Normal female blood androgen levels are generally only 10 to 20% of male, but “small qualifications, ability” – they are the ovarian synthesis of estrogen and progesterone raw materials; at the same time, for female puberty, bone and muscle development, distribution of body hair and sex drive Maintenance, are very important physiological significance. That is to say, so little androgen with a lot of estrogen and progesterone can make the girl really transform into a woman. Women synthesize androgens from two main “manufacturers”: the ovaries and the adrenal glands. In addition, muscle and fat also play the role of “cottage factories”, producing a very small amount of androgens. Often, what doctors refer to as androgens is actually a collective term for a number of hormones, commonly including testosterone, androstenedione and dehydroepiandrosterone. The first two androgens are mainly produced by the ovaries, while dehydroepiandrosterone is mainly synthesized and secreted by the adrenal glands. The Trouble with “Higher” Although proper androgens are essential for women, as the saying goes, “too much is not enough,” when a woman’s body’s androgen level or activity exceeds the normal range required, it is called hyperandrogenemia. Excessive androgens can cause a series of health problems for women of childbearing age. The first is the reproductive system lesions: high concentration of androgens will inhibit follicular development, resulting in a large number of immature small follicles accumulated in the ovaries; endometrium can not be normal growth, which should be the embryo bed “fertile soil” will become “barren desert”. Therefore, patients may show prolonged menstrual cycle (>35 days), secondary amenorrhea, infertility or miscarriage. Secondly, skin problems, many patients are “oily”, acne persistent, difficult to cure. In addition, many patients with hyperandrogenemia will appear hair abnormalities show a tendency of polarization: on the one hand, patients around the lips, chest line, areola and navel will appear similar to men’s dense cui hair, on the other hand, the patient often complains that hair often easy to fall out, hairline shift, and even the risk of baldness in serious cases. Hyperandrogenemia on the metabolic harm is not as obvious as the above performance, but the long-term impact on human health is more serious. Long-term hyperandrogenemia will lead to a series of “old age disease” in advance, such as hyperlipidemia, coronary heart disease, hypertension, diabetes and so on. Excessive androgen may also lead to increased nerve excitability, making the patient irritable; women of childbearing age may also experience anxiety, depression and other adverse emotional reactions out of concern for changes in masculine appearance. Of course, due to individualized differences, not every patient with hyperandrogenemia will have the above performance. The real culprit behind the worries In fact, the diagnostic name of hyperandrogenemia belongs only to the fog, which only describes the surface phenomenon and does not reflect the essence of the disease, because quite a number of diseases of different natures can appear with increased androgen levels or activity. The most common cause of hyperandrogenemia is polycystic ovary syndrome (PCOS), a condition that is perfectly compatible with hyperandrogenemia, but the two are not equivalent. There was a patient who left a deep impression on me: she was diagnosed with PCOS because of “irregular menstruation combined with infertility for 11 years”, and she took several sacks of Chinese and Western medicines to regulate menstruation and promote ovulation, but her blood androgens were repeatedly high, and of course, her stomach did not move at all. After careful physical examination, we found that she had high blood pressure and a typical “full moon face”, and it was only after blood, urine and ultrasound that we realized that she actually had a left adrenocortical adenoma, not PCOS. In addition, there are also many other diseases that have the manifestation of hyperandrogenism, such as thyroid dysfunction, hyperprolactinemia, ovarian membranous cell tumor and Cushing’s syndrome, and so on. Cushing’s syndrome, to name a few. Therefore, the specialist will use various tests to try to clear up the fog and reveal the underlying issues that lead to these phenomena. Therefore, it is not surprising that when a patient is suspected of hyperandrogenemia, the doctor recommends thyroid and adrenal function tests. Only when the doctor finds the “root cause” of the excess androgens and identifies the cause of the disease can he or she target the treatment. Treatment: Most women can still have children Once diagnosed with hyperandrogenemia (referred to as hyperandrogenism), many women start to worry. However, with regular treatment, most women with hyperandrogenism can have children and have a good quality of life. First of all, for all patients with hyperandrogenism, the first thing to do is to change the bad lifestyle, including: not staying up late, drinking less alcohol, active physical exercise (more than one hour of aerobic exercise per day) and balanced diet (especially avoiding junk food such as fast food and gutter oil). Based on our clinical experience, we would like to remind Kaohsiung patients that they should not take tonic Chinese medicines at will, and it is best not to add medicinal herbs to their daily soups. Some studies have found that after overweight or obese patients reduce their body weight through dietary adjustments and exercise, not only can blood levels of androgens and insulin improve faster, but also minimize the risk of cardiovascular and cerebral vascular diseases, and obtain longer-lasting results. Treatment strategies are individualized for each cause, source of androgens, and fertility requirements. Patients with PCOS are usually treated with short-acting birth control pills for 3-6 months; if insulin resistance is present, glucose-lowering medication may be added, and ovulation and fertility treatments can be initiated after the hyperandrogenic and hyperinsulinemic state has been effectively curbed. In the outpatient clinic of the Reproductive Center, many PCOS patients with combined infertility ask for assisted reproductive technology to help them conceive as soon as possible, and their urgency is understandable, but in fact, IVF is not the first choice of treatment for PCOS infertility, which has been included in the guidelines for the diagnosis and treatment of PCOS in Europe and the United States. After regular examination and treatment, most PCOS patients can have a natural pregnancy. It is important to note that hyperandrogenism in PCOS patients is prone to recurrent episodes of hyperandrogenism, and frequent monitoring of androgen status and appropriate management are needed even after pregnancy. In the case of hyperandrogenism of adrenocortical origin, drug therapy is often very effective. However, when it comes to androgen-producing tumors, which are more common in the ovaries and adrenal glands, a “one-size-fits-all” approach is often enough to achieve immediate results. Like the adrenocortical adenoma patient mentioned above, we referred her to the urology department for surgical removal of the tumor, her androgens soon dropped to normal, and she became pregnant naturally four months later. As for secondary hyperprolactinemia, thyroid disease and diabetes mellitus, the problem of hyperprolactinemia can be solved naturally after the primary disease is treated.