In the human body, the formation, development and functioning of the reproductive system is determined by a special class of substances – sex steroids. These hormones are produced in gonads (testicles in men, ovaries in women). A small amount of sex steroids and the adrenal cortex secretes.
Estrogens and gestagens are responsible for the presence of primary and secondary sexual characteristics, sexual desire, fertility in women, and androgens in men. All of these hormones in some quantity are present in the blood of each person. Sex differences are observed at the level of the relationship between estrogens and androgens.
Normally, women have only minimal levels of androgens in their blood.
Androgens in healthy women
Androgens in the female body are produced by the action of the tropic hormones of the pituitary gland. In this central endocrine gland, 2 main factors acting in this direction are synthesized – luteinizing and adrenocorticotropic hormones (LH and ACTH).
In a healthy woman of reproductive age, androgens (testosterone, dihydrotestosterone) and prohormones (androstenedione, dihydroepiandrosterone / DHEA /, dihydroepiandrosterone sulfate / DHEA-C /) are determined in the blood. Prohormones have their muscular action only after activation, that is, after turning into testosterone.
Almost 100% of DHEA enters the bloodstream from the cells of the reticular layer of the adrenal glands. A slight secretion of this hormone is also observed in ovarian theca cells.
Active testosterone in women is produced:
- in the ovaries (25%);
- in the adrenal glands (25%);
- in adipose tissue (50%).
Adipose cells do not synthesize androgens. But it is in the subcutaneous fat that prohormones are transformed into testosterone. With obesity or underweight, this process may be disrupted. Moreover, the balance sometimes shifts towards a lack of hormones, and sometimes – towards hyperandrogenism.
A woman of reproductive age produces about 300 micrograms of testosterone every day in the body. This amount can be considered insignificant compared with men. For men, on average, testosterone is produced 20 times more daily.
With age, the production of androgens in women decreases. Unlike estrogen, this decrease is not sharp. The production of hormones drops by a few percent every year after 30 years. At the age of 45, women have only half the androgen concentration in their blood, compared to twenty.
Androgens in women normally play several roles. These hormones can turn into estrogen (in the ovaries and adipose tissue). By itself, testosterone affects the nervous and reproductive system, muscle tissue, psychological sphere, metabolism in women.
- enhance the growth of skeletal muscles;
- promote bone mineralization;
- reduce the risk of anemia;
- activate the nervous system;
- improve logical thinking;
- increase libido;
- eliminate depression.
Women with a low level of male sex steroids are often unhappy with their state of health, have personal problems and get little pleasure in their sexual life. Postmenopausal patients have a higher risk of osteoporosis and fractures, anemia, severe depression.
Excessive production of testosterone and its predecessors leads to the appearance of male signs in women. If an increased concentration of androgens is observed during fetal development, then the girl is born with abnormally developed external genital organs. In such a newborn, the clitoris is enlarged, and the labia majora are spliced. Externally, the genitals are reminiscent of the structure of men. Sometimes a test is required to clarify the sex of the child.
In girls, excess testosterone can cause early maturation in a heterogeneous manner. Such children enter puberty early. They show signs of the opposite sex (a characteristic physique, excessive growth of hair on the face and body, a decrease in the tone of the voice).
In adult women, hyperandrogenism provokes:
- redistribution of adipose tissue;
- breast hypotrophy;
- hirsutism (hair growth in androgen-dependent zones);
- violation of the menstrual cycle;
Quite often, manifestations of elevated testosterone levels are hardly noticeable. Women consider excessive hair growth and problem skin to be simply a cosmetic problem.
If a girl has low androgen levels before puberty, her physical development may be somewhat delayed. Such children grow slowly, have insufficient weight and muscle strength.
Lack of testosterone in women of reproductive age leads to:
- decrease in sexual desire;
- deterioration in the quality of life;
- decrease in muscle bulk;
- chronic fatigue.
Postmenopausal patients have a higher risk of osteoporosis and fractures, anemia, severe depression.
The main causes of hyperandrogenism (increased)
Tumor processes, congenital anomalies, fermentopathies, and obesity can lead to an excess of testosterone in the female body.
The main reasons for the increase in hormone levels are:
- congenital dysfunction of the adrenal cortex;
- polycystic ovary syndrome;
- adrenal adenomas (androsteroma);
- tumors of the pituitary, hypothalamus, adrenal glands, ovaries;
- LH increase;
- Cushing’s disease;
With congenital dysfunction of the adrenal cortex in women, steroid synthesis is impaired. The body is experiencing a clear lack of vital glucocorticoids (primarily cortisol). Because of this, ACTH synthesis is activated in the pituitary gland. This tropic hormone enhances the synthesis of testosterone and its predecessors in the cortex.
Polycystic ovary syndrome occurs due to congenital insulin resistance. Most often, this pathology is manifested in women with overweight, hypertension, high cholesterol, impaired glucose tolerance. Excess testosterone in this case is produced in the ovaries.
Malignant and benign tumors of the endocrine tissues sometimes cause hyperandrogenism. Neoplasms can be localized in the adrenal glands, ovaries, hypothalamic-pituitary region.
LH imbalance increases testosterone levels in the second phase of the menstrual cycle (after ovulation).
Itsenko-Cushing disease is characterized by stable hypersecretion of ACTH and glucocorticosteroids. In patients, there is a redistribution of fatty tissue, striae, hypertension, steroid diabetes. Excess testosterone in this case appears due to excessive activity of the reticular zone of the adrenal cortex.
In hypothyroidism, total testosterone in women is more often normal, but the concentration of its biologically active form increases. This is due to a decrease in the production of a special carrier protein (sex-binding globulin) in the liver.
Causes of hypoandrogenism (lowered)
Testosterone deficiency in women may not be diagnosed for a long time. Reduced levels of testosterone and its predecessors are found with:
- ovarian pathologies (ovarian depletion, etc.);
- severe chronic diseases (heart failure, renal failure, etc.);
- endocrinopathies (panhypopituatism, secondary hypogonadism, adrenal insufficiency, etc.);
- treatment with some drugs.
Diagnosis and treatment
Diagnostics of testosterone levels in women are performed by endocrinologists and gynecologists.
The survey includes:
- collection of information about complaints, heredity, etc .;
- general inspection;
- gynecological examination;
- blood and urine tests for testosterone and its metabolites;
- study of the level of other hormones: gonadotropins, ACTH, thyreotropin, cortisol, estrogens;
- Pelvic ultrasound;
- Ultrasound of the adrenal glands.
It is known that the most accurate analysis to detect hyperandrogenism is the study of free testosterone. This indicator shows the concentration of the active hormone, and not its associated form.
Treatment depends on the causes of the disease. Always takes into account the age of the woman and her plans for the birth of children.
Treatment of polycystic ovaries is usually carried out with oral combination contraceptives and metformin. It is also possible surgical treatment (resection, coagulation).
Tumors of the adrenal glands, pituitary and hypothalamus, ovaries are surgically removed.
Correction of congenital dysfunction of the adrenal cortex is carried out medically. For the treatment using glucocorticoids.
Medical care for obesity and hypothyroidism is provided by an endocrinologist (therapist). The treatment of these diseases is usually conservative.