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Dermatology68 papers

Adrenogenital disorder

Last edited: 4/14/2026

Overview

Hyperandrogenism refers to a clinical state characterized by excess androgen production or action, leading to symptoms such as acne, hirsutism, alopecia, and menstrual irregularities in women 12318.

Diagnosis

  • Clinical Criteria: Acne, hirsutism, seborrhea, alopecia, and menstrual irregularities 11828.
  • Biochemical Tests: Elevated serum testosterone (total and free), DHEA-S, and sometimes AMH levels 192013.
  • Grading: Hyperandrogenism can be graded based on clinical manifestations and biochemical markers, with specific thresholds for testosterone levels aiding in diagnosis 2520.

    • Management

  • First-Line Treatments:
    • - Antiandrogen Therapy: Cyproterone acetate combined with ethinylestradiol 21224142. - Combined Oral Contraceptives (COCs): Continuous regimens for hirsutism, acne, and seborrhea 1421.
  • Adjunctive Treatments:
    • - Spironolactone: Oral and topical formulations for skin manifestations 30. - Low-Dose Flutamide: For severe cases in adolescents 6.

    Special Populations

  • Pediatrics: Hyperandrogenism in adolescents often manifests as hirsutism, acne, and menstrual irregularities; diagnosis and management require careful consideration of underlying causes like adrenal hyperplasia 32229.
  • Pregnancy: Specific management strategies for hyperandrogenic women during pregnancy are not extensively covered in the abstracts provided.
  • Comorbidities: Management may need to account for coexisting conditions like obesity, which can influence androgen levels 214.

    • Key Recommendations

  • Use Combined Oral Contraceptives for Symptom Management: Effective for treating hirsutism, acne, and seborrhea in hyperandrogenic women (Evidence: Moderate) 1421.
  • Consider Antiandrogen Therapy for Severe Cases: Cyproterone acetate combined with ethinylestradiol is recommended for severe hyperandrogenic symptoms (Evidence: Moderate) 214142.
  • Evaluate AMH Levels for Differential Diagnosis: Anti-Müllerian Hormone (AMH) can aid in distinguishing between different hyperandrogenic conditions (Evidence: Moderate) 13.
  • Monitor Androgen Levels Biochemically: Regular assessment of testosterone and DHEA-S levels is crucial for diagnosis and monitoring treatment efficacy (Evidence: Moderate) 1920.
  • Tailor Management in Adolescents: Consider underlying causes such as adrenal disorders in adolescent girls presenting with hyperandrogenism (Evidence: Moderate) 32229.

    • References

    1 Sardana K, Muddebihal A, Sehrawat M, Bansal P, Khurana A. An updated clinico-investigative approach to diagnosis of cutaneous hyperandrogenism in relation to adult female acne, female pattern alopecia & hirsutism a primer for dermatologists. Expert review of endocrinology & metabolism 2024. link 2 Zapała B, Marszalec P, Piwowar M, Chmura O, Milewicz T. Reduction in the Free Androgen Index in Overweight Women After Sixty Days of a Low Glycemic Diet. Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association 2024. link 3 Esquivel-Zuniga MR, Kirschner CK, McCartney CR, Burt Solorzano CM. Non-PCOS Hyperandrogenic Disorders in Adolescents. Seminars in reproductive medicine 2022. link 4 Winkler M, Gilleri G. Of Athletes, Bodies, and Rules: Making Sense of . The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics 2021. link 5 McQuoid-Mason DJ. Would it be ethical or legal for doctors in South Africa to administer testosterone-reducing drugs to Caster Semenya?. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2019. link 6 Fulghesu AM, Melis F, Murru G, Canu E, Melis GB. Very low dose of flutamide in the treatment of hyperandrogenism. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 2018. link 7 Rogol AD, Pieper LP. The Interconnected Histories of Endocrinology and Eligibility in Women's Sport. Hormone research in paediatrics 2018. link 8 Bitzer J, Römer T, Lopes da Silva Filho A. The use of cyproterone acetate/ethinyl estradiol in hyperandrogenic skin symptoms - a review. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception 2017. link 9 Brodsky JL, Genel M. The 2015 Pediatric Endocrine Society Ethics Symposium: Controversies Regarding 'Gender Verification' of Elite Female Athletes - Sex Testing to Hyperandrogenism. Hormone research in paediatrics 2016. link 10 Camporesi S. Ethics of Regulating Competition for Women with Hyperandrogenism. Clinics in sports medicine 2016. link 11 Allen DB. Hormonal Eligibility Criteria for 'Includes Females' Competition: A Practical but Problematic Solution. Hormone research in paediatrics 2016. link 12 Clark CM, Rudolph J, Gerber DA, Glick S, Shalita AR, Lowenstein EJ. Dermatologic manifestation of hyperandrogenism: a retrospective chart review. Skinmed 2014. link 13 Tuten A, Sahmay S, Oncul M, Acikgoz AS, Imamoglu M, Gurleyen HC et al.. Serum AMH levels in the differential diagnosis of hyperandrogenemic conditions. European journal of obstetrics, gynecology, and reproductive biology 2014. link 14 Caruso S, Cianci S, Malandrino C, Cicero C, Lo Presti L, Cianci A. Hyperandrogenic women treated with a continuous-regimen oral contraceptive. European journal of obstetrics, gynecology, and reproductive biology 2013. link 15 Caruso S, Rugolo S, Agnello C, Romano M, Cianci A. Quality of sexual life in hyperandrogenic women treated with an oral contraceptive containing chlormadinone acetate. The journal of sexual medicine 2009. link 16 Karrer-Voegeli S, Rey F, Reymond MJ, Meuwly JY, Gaillard RC, Gomez F. Androgen dependence of hirsutism, acne, and alopecia in women: retrospective analysis of 228 patients investigated for hyperandrogenism. Medicine 2009. link 17 Lello S, Primavera G, Colonna L, Vittori G, Guardianelli F, Sorge R et al.. Effects of two estroprogestins containing ethynilestradiol 30 microg and drospirenone 3 mg and ethynilestradiol 30 microg and chlormadinone 2 mg on skin and hormonal hyperandrogenic manifestations. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 2008. link 18 Yildiz BO. Diagnosis of hyperandrogenism: clinical criteria. Best practice & research. Clinical endocrinology & metabolism 2006. link 19 Stanczyk FZ. Diagnosis of hyperandrogenism: biochemical criteria. Best practice & research. Clinical endocrinology & metabolism 2006. link 20 Chen W, Chen GY, Tsai SJ, Wang PW, Sheu HM, Shen YS et al.. Mild cutaneous manifestation in two young women with extraordinary hyperandrogenemia. Dermatology (Basel, Switzerland) 2005. link 21 Schindler AE. Antiandrogenic progestins for treatment of signs of androgenisation and hormonal contraception. European journal of obstetrics, gynecology, and reproductive biology 2004. link 22 Huppert J, Chiodi M, Hillard PJ. Clinical and metabolic findings in adolescent females with hyperandrogenism. Journal of pediatric and adolescent gynecology 2004. link 23 Goolsby MJ. AACE hyperandrogenism guidelines. Journal of the American Academy of Nurse Practitioners 2001. link 24 Schroeder B. Early diagnosis, presenting complaints, and management of hyperandrogenism in adolescents. Current women's health reports 2001. link 25 Cibula D, Hill M, Starka L. The best correlation of the new index of hyperandrogenism with the grade of increased body hair. European journal of endocrinology 2000. link 26 Davis S. Syndromes of hyperandrogenism in women. Australian family physician 1999. link 27 Pucci E, Petraglia F. Treatment of androgen excess in females: yesterday, today and tomorrow. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 1997. link 28 Rosenfield RL, Lucky AW. Acne, hirsutism, and alopecia in adolescent girls. Clinical expressions of androgen excess. Endocrinology and metabolism clinics of North America 1993. link 29 Sultan C, Medlej R, Chevalier C, Lobaccaro JM. Management of hyperandrogenism in adolescent girls. Hormone research 1991. link 30 Messina M, Manieri C, Musso MC, Pastorino R. Oral and topical spironolactone therapies in skin androgenization. Panminerva medica 1990. link 31 McLaughlin B, Barrett P, Finch T, Devlin JG. Late onset adrenal hyperplasia in a group of Irish females who presented with hirsutism, irregular menses and/or cystic acne. Clinical endocrinology 1990. link 32 Vexiau P, Husson C, Chivot M, Brerault JL, Fiet J, Julien R et al.. Androgen excess in women with acne alone compared with women with acne and/or hirsutism. The Journal of investigative dermatology 1990. link 33 Vecsei P, Frank K, Haack D, Heinze V, Ho AD, Honour JW et al.. Primary glucocorticoid receptor defect with likely familial involvement. Cancer research 1989. link 34 Venturoli S, Porcu E, Gammi L, Fabbri R, Paradisi R, Flamigni C et al.. The effects of desogestrel and ethinylestradiol combination in normal and hyperandrogenic young girls: speculations on contraception in adolescence. Acta Europaea fertilitatis 1988. link 35 Lobo RA. Androgen excess and the infertile woman. Obstetrics and gynecology clinics of North America 1987. link 36 Jung-Hoffmann C, Taubert HD, Kuhl H. Direct radioimmunoassay of free testosterone in the evaluation of androgenetic manifestations in women. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 1987. link 37 Lucky AW, Rosenfield RL, McGuire J, Rudy S, Helke J. Adrenal androgen hyperresponsiveness to adrenocorticotropin in women with acne and/or hirsutism: adrenal enzyme defects and exaggerated adrenarche. The Journal of clinical endocrinology and metabolism 1986. link 38 Appelt H, Strauss B. Effects of antiandrogen treatment on the sexuality of women with hyperandrogenism. Psychotherapy and psychosomatics 1984. link 39 Steinberger E, Smith KD, Rodriguez-Rigau LJ. Testosterone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate in hyperandrogenic women. The Journal of clinical endocrinology and metabolism 1984. link 40 Wild RA, Umstot ES, Andersen RN, Ranney GB, Givens JR. Androgen parameters and their correlation with body weight in one hundred thirty-eight women thought to have hyperandrogenism. American journal of obstetrics and gynecology 1983. link90998-5) 41 Julesz J, Faredin I, Tóth I, László FA. Cyproterone acetate treatment of females with hyperandrogenism. Endokrinologie 1981. link 42 Nardi M, De Aloysio D, Busacchi P, Flamigni C. Cyproterone acetate - ethinylestradiol treatment of hirsutism, acne, seborrhea and alopecia. Acta Europaea fertilitatis 1975. link

    Original source

    1. [1]
      An updated clinico-investigative approach to diagnosis of cutaneous hyperandrogenism in relation to adult female acne, female pattern alopecia & hirsutism a primer for dermatologists. — Sardana K, Muddebihal A, Sehrawat M, Bansal P, Khurana A Expert review of endocrinology & metabolism (2024)
    2. [2]
      Reduction in the Free Androgen Index in Overweight Women After Sixty Days of a Low Glycemic Diet. — Zapała B, Marszalec P, Piwowar M, Chmura O, Milewicz T Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association (2024)
    3. [3]
      Non-PCOS Hyperandrogenic Disorders in Adolescents. — Esquivel-Zuniga MR, Kirschner CK, McCartney CR, Burt Solorzano CM Seminars in reproductive medicine (2022)
    4. [4]
      Of Athletes, Bodies, and Rules: Making Sense of — Winkler M, Gilleri G The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics (2021)
    5. [5]
      Would it be ethical or legal for doctors in South Africa to administer testosterone-reducing drugs to Caster Semenya? — McQuoid-Mason DJ South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (2019)
    6. [6]
      Very low dose of flutamide in the treatment of hyperandrogenism. — Fulghesu AM, Melis F, Murru G, Canu E, Melis GB Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology (2018)
    7. [7]
      The Interconnected Histories of Endocrinology and Eligibility in Women's Sport. — Rogol AD, Pieper LP Hormone research in paediatrics (2018)
    8. [8]
      The use of cyproterone acetate/ethinyl estradiol in hyperandrogenic skin symptoms - a review. — Bitzer J, Römer T, Lopes da Silva Filho A The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception (2017)
    9. [9]
      The 2015 Pediatric Endocrine Society Ethics Symposium: Controversies Regarding 'Gender Verification' of Elite Female Athletes - Sex Testing to Hyperandrogenism. — Brodsky JL, Genel M Hormone research in paediatrics (2016)
    10. [10]
      Ethics of Regulating Competition for Women with Hyperandrogenism. — Camporesi S Clinics in sports medicine (2016)
    11. [11]
      Hormonal Eligibility Criteria for 'Includes Females' Competition: A Practical but Problematic Solution. — Allen DB Hormone research in paediatrics (2016)
    12. [12]
      Dermatologic manifestation of hyperandrogenism: a retrospective chart review. — Clark CM, Rudolph J, Gerber DA, Glick S, Shalita AR, Lowenstein EJ Skinmed (2014)
    13. [13]
      Serum AMH levels in the differential diagnosis of hyperandrogenemic conditions. — Tuten A, Sahmay S, Oncul M, Acikgoz AS, Imamoglu M, Gurleyen HC et al. European journal of obstetrics, gynecology, and reproductive biology (2014)
    14. [14]
      Hyperandrogenic women treated with a continuous-regimen oral contraceptive. — Caruso S, Cianci S, Malandrino C, Cicero C, Lo Presti L, Cianci A European journal of obstetrics, gynecology, and reproductive biology (2013)
    15. [15]
      Quality of sexual life in hyperandrogenic women treated with an oral contraceptive containing chlormadinone acetate. — Caruso S, Rugolo S, Agnello C, Romano M, Cianci A The journal of sexual medicine (2009)
    16. [16]
      Androgen dependence of hirsutism, acne, and alopecia in women: retrospective analysis of 228 patients investigated for hyperandrogenism. — Karrer-Voegeli S, Rey F, Reymond MJ, Meuwly JY, Gaillard RC, Gomez F Medicine (2009)
    17. [17]
      Effects of two estroprogestins containing ethynilestradiol 30 microg and drospirenone 3 mg and ethynilestradiol 30 microg and chlormadinone 2 mg on skin and hormonal hyperandrogenic manifestations. — Lello S, Primavera G, Colonna L, Vittori G, Guardianelli F, Sorge R et al. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology (2008)
    18. [18]
      Diagnosis of hyperandrogenism: clinical criteria. — Yildiz BO Best practice & research. Clinical endocrinology & metabolism (2006)
    19. [19]
      Diagnosis of hyperandrogenism: biochemical criteria. — Stanczyk FZ Best practice & research. Clinical endocrinology & metabolism (2006)
    20. [20]
      Mild cutaneous manifestation in two young women with extraordinary hyperandrogenemia. — Chen W, Chen GY, Tsai SJ, Wang PW, Sheu HM, Shen YS et al. Dermatology (Basel, Switzerland) (2005)
    21. [21]
      Antiandrogenic progestins for treatment of signs of androgenisation and hormonal contraception. — Schindler AE European journal of obstetrics, gynecology, and reproductive biology (2004)
    22. [22]
      Clinical and metabolic findings in adolescent females with hyperandrogenism. — Huppert J, Chiodi M, Hillard PJ Journal of pediatric and adolescent gynecology (2004)
    23. [23]
      AACE hyperandrogenism guidelines. — Goolsby MJ Journal of the American Academy of Nurse Practitioners (2001)
    24. [24]
      Early diagnosis, presenting complaints, and management of hyperandrogenism in adolescents. — Schroeder B Current women's health reports (2001)
    25. [25]
      The best correlation of the new index of hyperandrogenism with the grade of increased body hair. — Cibula D, Hill M, Starka L European journal of endocrinology (2000)
    26. [26]
      Syndromes of hyperandrogenism in women. — Davis S Australian family physician (1999)
    27. [27]
      Treatment of androgen excess in females: yesterday, today and tomorrow. — Pucci E, Petraglia F Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology (1997)
    28. [28]
      Acne, hirsutism, and alopecia in adolescent girls. Clinical expressions of androgen excess. — Rosenfield RL, Lucky AW Endocrinology and metabolism clinics of North America (1993)
    29. [29]
      Management of hyperandrogenism in adolescent girls. — Sultan C, Medlej R, Chevalier C, Lobaccaro JM Hormone research (1991)
    30. [30]
      Oral and topical spironolactone therapies in skin androgenization. — Messina M, Manieri C, Musso MC, Pastorino R Panminerva medica (1990)
    31. [31]
      Late onset adrenal hyperplasia in a group of Irish females who presented with hirsutism, irregular menses and/or cystic acne. — McLaughlin B, Barrett P, Finch T, Devlin JG Clinical endocrinology (1990)
    32. [32]
      Androgen excess in women with acne alone compared with women with acne and/or hirsutism. — Vexiau P, Husson C, Chivot M, Brerault JL, Fiet J, Julien R et al. The Journal of investigative dermatology (1990)
    33. [33]
      Primary glucocorticoid receptor defect with likely familial involvement. — Vecsei P, Frank K, Haack D, Heinze V, Ho AD, Honour JW et al. Cancer research (1989)
    34. [34]
      The effects of desogestrel and ethinylestradiol combination in normal and hyperandrogenic young girls: speculations on contraception in adolescence. — Venturoli S, Porcu E, Gammi L, Fabbri R, Paradisi R, Flamigni C et al. Acta Europaea fertilitatis (1988)
    35. [35]
      Androgen excess and the infertile woman. — Lobo RA Obstetrics and gynecology clinics of North America (1987)
    36. [36]
      Direct radioimmunoassay of free testosterone in the evaluation of androgenetic manifestations in women. — Jung-Hoffmann C, Taubert HD, Kuhl H Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology (1987)
    37. [37]
      Adrenal androgen hyperresponsiveness to adrenocorticotropin in women with acne and/or hirsutism: adrenal enzyme defects and exaggerated adrenarche. — Lucky AW, Rosenfield RL, McGuire J, Rudy S, Helke J The Journal of clinical endocrinology and metabolism (1986)
    38. [38]
      Effects of antiandrogen treatment on the sexuality of women with hyperandrogenism. — Appelt H, Strauss B Psychotherapy and psychosomatics (1984)
    39. [39]
      Testosterone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate in hyperandrogenic women. — Steinberger E, Smith KD, Rodriguez-Rigau LJ The Journal of clinical endocrinology and metabolism (1984)
    40. [40]
      Androgen parameters and their correlation with body weight in one hundred thirty-eight women thought to have hyperandrogenism. — Wild RA, Umstot ES, Andersen RN, Ranney GB, Givens JR American journal of obstetrics and gynecology (1983)
    41. [41]
      Cyproterone acetate treatment of females with hyperandrogenism. — Julesz J, Faredin I, Tóth I, László FA Endokrinologie (1981)
    42. [42]
      Cyproterone acetate - ethinylestradiol treatment of hirsutism, acne, seborrhea and alopecia. — Nardi M, De Aloysio D, Busacchi P, Flamigni C Acta Europaea fertilitatis (1975)
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