Hyperandrogenism

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Hyperandrogenism, or androgen excess, is a medical condition characterized by excessive levels of androgens in the body and the associated effects of these excessive levels of androgens.

Hyperandrogenism is one of the primary symptoms of polycystic ovary syndrome (PCOS). In such cases, it presents with symptoms such as acne and seborrhea, is frequent in adolescent girls and is often associated with irregular menstrual cycles. In most instances, these symptoms are transient and reflect only the immaturity of the hypothalamic-pituitary-ovarian axis during the first years following menarche.[1] Approximately three-quarters of patients with PCOS (by the diagnostic criteria of NIH/NICHD 1990) have evidence of hyperandrogenism, with free testosterone being the single most predictive marker with ~60% of patients demonstrating supranormal levels.[2]

Hyperandrogenism can also be the result of excessive production of adrenal or gonadal androgens by adrenal adenomas, carcinomas, or hyperplasia, Leydig cell tumors in men, and arrhenoblastomas in women.[3]:501–2

In women, signs and symptoms of hyperandrogenism frequently include acne, scalp hair loss (androgenic alopecia), excessive facial and body hair (hirsutism), atypically high libido, breast atrophy, and others. Collectively, these symptoms are described as virilization.

Management of hyperandrogenism symptoms like androgenic alopecia, include the use of antiandrogens such as cyproterone acetate, spironolactone, and flutamide.[4][5][6][7]

Sports[edit]

In international sports and the Olympic Games, a female athlete is not eligible to participate in the female category if the amount of androgenic hormone exceeds the permissible limits, on the ground that the condition could confer an unfair advantage.[8][9] The permissible limit was set at 10 nmol/L, based on a study done of all the women competing in the World Championships in 2011 and 2013.[10] 99% of the female athletes at those competitions had testosterone levels below 3.08 nmol/L.[11] So the upper limit of 10 nmol/L was more than 3 times higher than the testosterone levels of 99% of the elite female athletes in those competitions. However, a study of endocrine profiles in 693 elite athletes published in 2014 found that, while 13.7% of women athletes had high levels of testosterone, 16.5% of men had low levels of testosterone levels. The authors noted that there is "complete overlap between the sexes", concluding, "The IOC definition of a woman as one who has a ‘normal’ testosterone level is untenable."[12][13]

In September 2014, Dutee Chand, a sprinter from India who was barred by the International Association of Athletics Federations (IAAF) from competing against other female runners, sought to appeal the ruling and asked for reinstatement.[14] In July 2015, the Court of Arbitration for Sport suspended the IAAF ban, thus reinstating Chand's right to compete. The IAAF was given two years in which to file scientific evidence justifying the ban. In the absence of that, the ban will be declared void.[15][16][17]

See also[edit]

References[edit]

  1. ^ Christine Cortet-Rudelli; Didier Dewailly (Sep 21, 2006). "Diagnosis of Hyperandrogenism in Female Adolescents". Hyperandrogenism in Adolescent Girls. Armenian Health Network, Health.am. Retrieved 2006-11-21. 
  2. ^ Huang A, Brennan K, Azziz R (April 2010). "Prevalence of hyperandrogenemia in the polycystic ovary syndrome diagnosed by the National Institutes of Health 1990 criteria". Fertil. Steril. 93 (6): 1938–41. doi:10.1016/j.fertnstert.2008.12.138. PMC 2859983free to read. PMID 19249030. 
  3. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  4. ^ Tosti A, Camacho-Martinez F, Dawber R. Management of androgenetic alopecia. J Eur Acad Dermatol Venereol. 1999 May;12(3):205-14
  5. ^ Diamanti-Kandarakis E. Current aspects of antiandrogen therapy in women. Curr Pharm Des. 1999;5(9):707-23
  6. ^ Sinclair R, Wewerinke M, Jolley D.Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005 Mar;152(3):466-73
  7. ^ Vierhapper H, Maier H, Nowotny P, Waldhäusl W. Production rates of testosterone and of dihydrotestosterone in female pattern hair loss. Metabolism. 2003 Jul;52(7):927-9
  8. ^ "STANDARD OPERATIVE PROCEDURE to identify Circumstances (Female Hyperandrogenism) in Which A Particular Sports Person will not be eligible to participate in Competitions in the Female Category". 
  9. ^ http://pib.nic.in/archieve/others/2013/mar/d2013032001.pdf
  10. ^ "Hyperandrogenism and women vs women vs men in sport: A Q&A with Joanna Harper". 
  11. ^ "Hyperandrogenism and women vs women vs men in sport: A Q&A with Joanna Harper". 
  12. ^ Healy, M. L.; Gibney, J.; Pentecost, C.; Wheeler, M. J.; Sonksen, P. H. (August 2014). "Endocrine profiles in 693 elite athletes in the postcompetition setting". Clinical Endocrinology. 81 (2): 294–305. doi:10.1111/cen.12445. ISSN 0300-0664. Retrieved 2016-08-17. 
  13. ^ Stewart, Erin (August 17, 2016). "Haters and hyperandrogenism: Caster Semenya's road to becoming an Olympic favourite". SBS. Retrieved 2016-08-17. 
  14. ^ "Fighting for the Body She Was Born With". The New York Times. 7 October 2014. 
  15. ^ "Dutee Chand, Female Sprinter With High Testosterone Level, Wins Right to Compete". The New York Times. 28 July 2015. 
  16. ^ http://www.tas-cas.org/fileadmin/user_upload/Media_Release_3759_FINAL.pdf
  17. ^ "Dutee Chand cleared to race as IAAF suspends 'gender test' rules". BBC News Online. 27 July 2015. Retrieved 27 July 2015.