South African athlete Caster Semenya didn’t participated in the 2019 World Athletics Championships because of hyperandrogenism. What exactly is it all about? Decode with Dr. Emmanuelle Lecornet-Sokol, endocrinologist and coauthor of “Et si c’était hormonal?” (Hachette bien-être).
Caster Semenya, a two-time Olympic champion and three-time world champion in the 800 meters, has been excluded from the World Athletics Championships in Doha, scheduled for Sept. 27 to Oct. 6, 2019. The South African athlete opposes International Association of Athletics Federations (IAAF) rules requiring hyperandrogenic athletes to take testosterone-lowering drugs. This controversy sheds light on a little-known syndrome hyperandrogenism. What is it? What are the causes and possible treatments? An update from Dr. Emmanuelle Lecornet-Sokol, endocrinologist.
What is hyperandrogenemia?
Hyperandrogenism refers to a excess of male hormones in women, where androgens refer to male sex hormones.
Women produce many female hormones (the main ones being estradiol and progesterone) and some male hormones, the best known of which is testosterone. Sometimes dysfunction causes excessive production of these male hormones, which is responsible for hyperandrogenism.
What are the symptoms of hyperandrogenism?
This is manifested by symptoms related to masculinity, the three main ones of which are:
- ofacne On the face, over the chest, upper back, buttocks
- Excessive hair growth in normal areas (e.g., underarm hair) and in areas normally devoid of hair, this is called hirsutism. In women, hair grows on the upper lip, chin, cheeks, and neck, between the breasts and around the areolas, on the white line of the abdomen (line across the navel), on the lumbar region (lower back), and on the inner thighs.
Hirsutism is the most common symptom of hyperandrogenism and is one of the most frequent reasons for consultation in endocrinology.
- HAIR LOSSThis is called androgenetic alopecia, which is particularly prevalent on the top of the head and frontal lobes (great forehead).
These symptoms are often accompanied by menstrual disorders, absence of menstruation (amenorrhea) or prolonged cycles with irregular menses that do not occur every month.
Hyperandrogenism is clinically confirmed by three main symptoms: excessive acne and/or hair growth and/or hair loss. Depending on their intensity, they are referred to as a minor or major form of hyperandrogenism.
The existence of hyperandrogenism is confirmed biologically by a Androgen hormone: blood test Of which the main one is testosterone. The physician can also measure SDHEA (a natural hormone produced by the adrenals) and delta 4 androstenedione.
Causes of hyperandrogenism
- From pathologies may be involved in the occurrence of this excess of androgen hormones. The best known and most frequent is. polycystic ovary syndrome (PCOS), also known as ovarian dystrophy. Although 10% of women are affected, this disease is not widely known, but it was recently made known with the revelation that young youtuber Enjoy Phoenix has the condition. ovarian dysfunction.
PCOS has three main symptoms: hyperandrogenism, long and irregular menstrual cycles, and ovarian abnormalities visible on ultrasound. PCOS is more common in overweight women.
- From genetic diseases can explain hyperandrogenism. For example, genetic mutations can interfere with the hormone formation cycle in the adrenal glands, resulting in an excess of androgens. This manifests in two forms: sexual ambiguity from birth (a girl with masculinized genitalia) or hirsutism at puberty. The most common is 21-hydroxylase deficiency.In severe forms, it may be associated with adrenal insufficiency that manifests from the earliest days of life with dehydration and hypoglycemia.
- Adrenal tumors or pituitary gland: this is referred to as hypercorticism or Cushing’s syndrome (hypersecretion of cortisol by the adrenal glands).Very rarely, there are also ovarian tumors Producing an excessive amount of androgens.
Treatments for hyperandrogenism
- If a tumor is present, it can often be removed by surgery.
- If it is a genetic disease, specific care for this condition is provided by rare disease centers.
- If polycystic ovary syndrome is responsible, there is no cure. However, it is possible to “put the ovaries to rest.” By administering a combined pill. For women with problems such as acne or hirsutism, the pill (second or, in cases of poor tolerance, third generation) is quite effective.
- If the pill does not work, the most effective medication for PCOS symptoms is thecyproterone acetate (Androcur®). This treatment was recently controversial because in rare cases of high-dose, very long-term use, cyproterone acetate increases the risk of meningioma (benign brain tumor).
- The spironolactone is another possible drug for hyperandrogenism. It acts on the adrenal glands by blocking androgen hormones. But this drug, initially used in hypertension, is not licensed in France for use in hyperandrogenism.
- Women treated with hormonal therapies (pill or cyproterone acetate) often supplement with local treatments by dermatologist as the laser To reduce hair growth or topical or even antibiotics to better control acne.
The impact of lifestyle on symptom reduction
Lifestyle modification can improve the symptoms of hyperandrogenism, particularly in PCOS. The practice of Sports and balanced diet (eating local and seasonal produce, filling up on fruits and vegetables, limiting meat, industrial products that are too fatty, too sweet and too salty, etc.) results in improvement of symptoms (slowing of hair growth, decrease in acne, etc.) of hyperandrogenism.
In contrast, the weight gain and a sedentary lifestyle aggravate the symptoms.
Thanks to Dr. Emmanuelle Lecornet-Sokol, endocrinologist.