Persistent acne, thinning hair on the crown, unwanted facial hair, irregular periods, mood swings, and unexplained weight gain—these symptoms affect millions of women worldwide, yet they are often dismissed as merely cosmetic issues. In reality, they may signal a deeper, frequently underdiagnosed hormonal imbalance known as androgen excess.
Androgens, often referred to as “male hormones,” are naturally present in all women. Problems arise when these hormone levels become elevated, disrupting multiple bodily systems including menstrual regulation, fertility, metabolism, and mental health. Despite its prevalence—impacting at least one in ten women globally—this condition remains widely misunderstood and frequently overlooked by healthcare providers.
Beyond PCOS: The Spectrum of Androgen Excess
Polycystic ovary syndrome (PCOS) is the most recognized cause of androgen excess, affecting up to 13% of women worldwide and costing the U.S. an estimated $15 billion annually. However, PCOS is not the sole driver of elevated androgen levels. Other conditions, such as hormone-secreting tumors, congenital adrenal hyperplasia, Cushing’s syndrome, and severe insulin resistance, can also cause androgen imbalance. Unfortunately, the tendency to attribute all cases to PCOS can delay the diagnosis of these rarer but potentially serious disorders.
The Wide-Ranging Impact of Androgen Excess
The effects extend far beyond visible symptoms. Insulin resistance, common among women with PCOS, increases the risk of type 2 diabetes, while many face challenges with elevated body weight, hypertension, liver disease, and cardiovascular complications. Moreover, hormonal imbalances can profoundly affect mental health, with anxiety and depression occurring two to three times more frequently in women with PCOS than in the general population.
For some women, infertility is the catalyst for seeking medical help. Yet many others suffer silently, their symptoms dismissed or minimized. Studies show that women with PCOS often wait more than two years and consult multiple healthcare professionals before receiving an accurate diagnosis. Nearly half report that their concerns were initially ignored.
Rethinking PCOS: A Misleading Name
The term “polycystic ovary syndrome” can be misleading. Many women diagnosed with PCOS do not have ovarian cysts, and having cysts alone does not necessarily indicate the condition. PCOS is a complex metabolic and hormonal disorder—not simply a reproductive one. Recognizing this, experts and patient advocates are calling for a name change to better reflect the condition’s broad effects, hoping to improve awareness, diagnosis, and treatment.
New Clinical Guidelines Offer Hope
In a significant advance, the UK’s Society for Endocrinology released updated clinical guidelines in June 2024 to improve the recognition and management of androgen excess. These guidelines provide clear diagnostic pathways, specify when to perform blood tests or imaging, and outline referral criteria for specialist care. Importantly, they emphasize that androgen excess affects women across all age groups, not just those of reproductive age.
Bridging the Gaps: What Needs to Change
Publication of guidelines is a critical first step, but meaningful progress requires sustained efforts:
Increased Research Funding: The causes of androgen excess and symptom variability remain poorly understood. Greater investment in women’s health research is urgently needed to uncover underlying mechanisms and develop effective treatments.
Enhanced Healthcare Training: Primary care providers, gynecologists, dermatologists, and mental health professionals must be better equipped to identify symptoms and understand when to initiate further investigation.
Accessible Patient Information: Clear, trustworthy resources can empower women to recognize warning signs and advocate for appropriate care, reducing reliance on unreliable online sources.
Holistic, Integrated Care: Androgen excess impacts—and is influenced by—mental health, metabolism, lifestyle, and reproductive function. Successful management requires a comprehensive approach rather than isolated treatments.
A Call to Action
Though often invisible to those not affected, androgen excess has profound physical and psychological consequences. For too long, it has been neglected. With improved awareness, robust research, and coordinated care, the medical community can better support women living with this complex condition—ensuring symptoms are acknowledged, treated promptly, and addressed with the compassion they deserve.
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