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Androgen Excess

Q: I'm 32 and I've always been mostly self-confident about my appearance, but that changed last year when I noticed hair beginning to grow on my face and out of my nose. As if that's not bad enough, I'm also showing signs of balding! I'm pretty health-conscious. I eat well and exercise when I can. What's going on, and how can I make it stop?

Dr. Donnica:
While it's impossible to know exactly what's going on without more information, your levels of androgens, or "male hormones," may be elevated. This is called "androgen excess," a fairly common situation for women your age, resulting from one of many causes of hormonal imbalance. It's time to see your gynecologist. She will take a complete history.
If your periods have also been affected, you may have "polycystic ovary syndrome" (also known as PCOS, Stein-Leventhal Syndrome or Polycystic Ovary Disease), which affects up to 10% of all American women, many of whom are unaware that they are affected. There is no test to confirm PCOS. The diagnosis is made by eliminating other conditions and by reported symptoms. In addition to causing the symptoms you've described, it is also one of the leading causes of infertility in women. Other symptoms may include unexplained weight gain (or difficulty losing weight), acne, and unwanted hair growth on the chest or back. While the cause is unknown, it is often treatable with medication, dietary changes and exercise; it is not "curable." While your symptoms sound primarily cosmetic, this is not just a cosmetic problem and should be addressed sooner rather than later.

A 15-year study from researchers at the Cedars Sinai Hospital in California published in the Journal of Clinical Endocrinology and Metabolism (Feb. 2004) evaluated the most common causes of androgen excess in women. Of their 873 patients, two-thirds were 30 years old or younger; 20% were below age 20 at the time of their first visit. Despite seeing top experts, only 7% of the patients had specific, identifiable disorders causing their androgen excess. These included a very small number of cancers, adrenal abnormalities, and a syndrome called "hyperandrogenic insulin-resistant acanthosis nigricans" or HAIRAN. The remaining patients were diagnosed based on their symptoms after excluding other disorders. About 82% of these women were diagnosed with PCOS. While most symptoms did improve with combination hormonal therapy, hair loss was reluctant to respond: it improved in only 33% of affected patients.

Created: 7/5/2004  -  Donnica Moore, M.D.

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