Hyperandrogenism

Hyperandrogenism is the effect of excess androgens, the hormones present at higher levels in men, in a woman's body. The signs include excess hair on the face or body, acne, thinning scalp hair, and irregular cycles. Blood tests can also show it. The 1990 NIH criteria for polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS), required two findings at the same time. These were signs of high androgen and cycles with rare or absent ovulation. Other causes had to be ruled out first.¹ The Androgen Excess and PCOS Society criteria also require high androgen. They add an ovarian finding, such as absent ovulation or polycystic ovaries.¹ High androgen is one of the three Rotterdam features.² The 2023 international guideline keeps the Rotterdam framework and requires any two of the three features.³

Blood tests confirm high androgen. Clinicians measure free or total testosterone, DHEA-S, and androstenedione. They compare each result with the normal range for a woman's age. Identifying the source matters. The excess androgen can come from the ovaries or from the adrenal glands, which sit above the kidneys. A high DHEA-S points toward the adrenal glands. High testosterone and androstenedione point toward the ovaries. One adrenal condition, congenital adrenal hyperplasia, can closely resemble PMOS / PCOS. A blood test for 17-hydroxyprogesterone screens for its milder form.⁴ Clinicians must rule it out before a diagnosis of PMOS / PCOS is final.

Restorative reproductive medicine identifies the source of excess androgen before any treatment begins. The goal is to correct the cause, not to mask the signs with suppressive medications. Once the source is clear, clinicians can treat the underlying problem. Correcting the cause is the restorative standard.