I. The role and source of androgens
Women’s development, beauty and beautiful posture depend on the normal secretion of estrogen and progesterone in our body, especially the cooperation and coordination of these hormones are needed for normal pregnancy. However, we always overlook some small amounts of hormones, such as androgens, which we are going to introduce to you today. Although androgens account for a relatively small portion of women’s body, only about 10% of men’s, they have a “significant” role – they can It promotes the development of female vulva, the growth of armpit and pubic hair, stimulates the growth of red blood cells and, most importantly, is the raw material for the synthesis of estrogen and progesterone in our body. This means that abnormal secretion of androgens will inevitably affect the secretion of estrogen and progesterone, which will lead to a series of harmful symptoms and chain reactions. Today, we would like to introduce you to this hormone, which is related to women’s menstruation, fertility and even their lifelong health!
There are two main sources of androgen synthesis in women: the ovaries and the adrenal glands. There are several types of androgens, including testosterone, androstenedione and dehydroepiandrosterone. The first two types of androgens are mainly produced by the ovaries, while dehydroepiandrosterone is mainly synthesized and secreted by the adrenal glands.
The “culprits” of high androgens
Excessive androgen levels and increased activity in women’s blood are called hyperandrogenemia. The main sources of androgens are the ovaries and the adrenal glands, and naturally there are ovarian and adrenal factors that cause this disorder respectively. It is reported that about 34% of the cases originate from polycystic ovary syndrome (PCOS), followed by hyperadrenocorticism, accounting for 29%, and a few are seen in follicular membrane hyperplasia and adrenal cortical hyperplasia; about 28% are of unknown origin.
1, ovarian factors: PCOS is the most important cause of hyperandrogenemia in women, 70%-80% of PCOS patients with hyperandrogenemia. Secondly, there are androgen-secreting ovarian tumors, which are generally small and not easily detected, so a significant increase in androgen measurement can help in the diagnosis.
Adrenal factors: congenital adrenocortical hyperplasia (CAH) and cortisolism are not only symptoms of hyperandrogenism, but also symptoms such as “full moon face and buffalo back” in some patients.
Third, the “dangers” of high androgens!
What are the dangers of hyperandrogenism?
Recent hazards: 1.
1. Skin manifestations: The primary manifestation of hyperandrogenism, hirsutism, acne and androgenetic alopecia are typical skin manifestations of hyperandrogenemia, especially not only the hair on the limbs, pubic area and armpits, but also the embarrassing hair on the upper lip, nipples and abdomen of female friends. However, the degree of hirsutism is not parallel to the androgen level. The most stimulating effect on hair is dihydrotestosterone, and when this hormone is elevated in the body, even when testosterone is normal, it can lead to hirsutism. Also, hirsutism is often accompanied by symptoms such as seborrhea and oily skin. Androgenetic alopecia occurs less and later, and acne is more common in teenage patients. Therefore, mothers, when your children have long-term persistent acne, accompanied by irregular menstruation, it is likely that they have high androgenic skin manifestations and need to go to the hospital for the corresponding examination!
2. Menstrual disorders and infertility: High androgens interfere with the growth and development of female follicles, leading to ovulation disorders and luteal insufficiency, which are the basis for the normal growth and development of follicles, and then cause menstrual disorders, scanty menstruation, amenorrhea and infertility. According to a large sample survey, half of the women with PCOS have primary infertility and another quarter have secondary infertility. Therefore, it is recommended that patients with PCOS who are interested in pregnancy still need to monitor ovulation.
3, masculine features: more androgens can lead to some male features in women, such as low voice tone, prominent laryngeal nodes, pubic emperor hypertrophy, male type pubic hair distribution, temporal baldness, and even cause breast atrophy in patients.
4. Bad pregnancy outcome: Women should know that even after a normal pregnancy, high androgens can affect pregnancy. It was originally mentioned that high androgens can affect the luteal function, and in the early stage of pregnancy, what is needed is the support of the corpus luteum of pregnancy, so this is inevitably unfavorable to pregnancy, and is likely to lead to miscarriage, and also may cause problems in the sex differentiation of the fetus and fetal malformations. In the later stages, studies have shown that it may lead to adverse pregnancy complications related to pre-eclampsia, premature rupture of membranes, gestational diabetes, and preterm delivery.
Long-term hazards.
1. Cardiovascular diseases: Long-term high androgens may cause metabolic disorders in patients, predisposing them to obesity, hypertension, dyslipidemia and coronary heart disease, increasing the incidence and mortality of cardiovascular diseases. Some studies have shown that triglycerides are the earliest lipid indicators that show abnormalities in hyperandrogenemia, and the problem of overweight and obesity is very serious, which is also a crucial factor leading to increased insulin resistance and disorders of glucolipid metabolism. Therefore, women should be alert to the fact that if their waist circumference thickens, they should consider having hyperandrogenism.
2, obesity, insulin resistance and diabetes: obesity, especially abdominal obesity, is associated with hyperandrogenemia and can also increase the risk of metabolic abnormalities. Compared with Kaohsiung patients with normal weight, menstrual disorders and sporadic ovulation are more common in obese patients. Also, the incidence of impaired glucose tolerance and type 2 diabetes is 5-10 times higher in hyperandrogenic patients than in normal people. As mentioned above, the dyslipidemia and obesity caused by Kaohsiung may further lead to disorders of glucose metabolism, which in turn increases the risk of insulin resistance and diabetes. Therefore, when you have symptoms of Kaohsiung, you need to beware of diabetes and other comorbidities and go to the hospital for glucose tolerance and insulin check in time.
3.Endometrial cancer: High androgens interfere with female ovulation, and long-term non-ovulation leads to continuous endometrial hyperplasia, which may even develop into endometrial cancer at a later stage. Meanwhile, obesity, insulin resistance and diabetes caused by high androgens are all risk factors of endometrial cancer, especially for older patients with abnormal uterine bleeding, they should be alert to endometrial cancer and undergo diagnostic scraping if necessary.
4.Psychological problems: Infertility, abnormal menstruation, masculine features, miscarriage and long-term disturbance of cardiovascular diseases will certainly increase the psychological burden of such patients, and the tendency of depression and suicide is higher than that of normal people. Therefore, it is necessary to take a detailed medical history of these patients, so that the “tip of the iceberg” can be detected early and treated accordingly.
Treatment of hyperandrogenism
For different causes, patients should be treated individually to reduce the production and action of androgens and relieve symptoms.
1. If the tumor is caused by ovarian or adrenal gland-related tumors, the corresponding tumor resection should be performed. However, for adrenal gland related diseases such as adrenal cortical hyperplasia and hypercorticism, medication can be used. As for hyperprolactinemia and thyroid-related diseases, treatment of the primary disease is the fundamental problem.
2.All patients with Kaohsiung, the primary should strengthen physical exercise and good eating habits, can help them lose weight and control their weight under the guidance of doctors, which can reduce the level of insulin resistance, alleviate the long-term metabolic disorders and reduce the incidence of cardiovascular diseases.
3, the most common cause of Kaohsiung is polycystic ovary syndrome, in clinical practice, this type of patients usually need medication to reduce androgens, at the same time, some patients also have disorders of blood sugar metabolism, need to combine the use of hypoglycemic drugs. It is worth noting that PCOS is often a lifelong disease and patients need to monitor their androgens and blood glucose repeatedly. Even after having children, they still need to pay attention to their hyperandrogenism and deal with it in a timely manner according to professional doctors’ advice.
In conclusion, hyperandrogenemia may last throughout the patient’s life and affect the cardiovascular system, endocrine metabolic system, reproductive system and other aspects. We need to recognize it, pay constant attention to it, deal with it under the guidance of a professional doctor and prevent various long-term complications.