Effects of sex steroids on women's health: implications for practitioners.

ABSTRACT

PIP: 5-10% of all women have an androgen excess syndrome. Androgen excess signs and symptoms include hirsutism, acne, central obesity, male-pattern baldness, upper torso widening, increased waist-to-hip ratio, clitoral hypertrophy, and deepening of the voice. Physicians must be able to recognize these signs and symptoms. Presence of these signs and symptoms calls for a screening history and physical examination. Differential diagnoses of androgen excess in women include endogenous and exogenous causes. Endogenous-related diagnoses are those of ovarian origin (primary tumors, metastatic tumors, polycystic ovary syndrome, ovarian stromal hyperthecosis, androgen excess in pregnancy, and abnormal gonadal or sexual development) and those of adrenal origin (Cushing's syndrome/disease, late-onset congenital adrenal hyperplasia, and tumors). Exogenous causes of androgen excess include Danazol, Phenytoin, Diazoxide, Hexachlorobenzene, Hexachlorophene, Minoxidil, Cyclosporin, testosterone and other androgens, anabolic steroids, synthetic progestins (the pill), and Metapyrone. When physicians treat patients for one symptom of androgen excess, they should watch for other signs and symptoms. Serious health risks associated with androgen excess include cardiovascular disease, intravascular thrombosis, and insulin resistance. Physicians must be aware that timely clinical recognition of androgen excess, knowledge of androgen-related biochemical abnormalities underlying the risks linked to androgen excess, and risk modification behavior reduces associated morbidity and mortality. Risk reduction strategies are correction of dyslipidemias, low-dose aspirin for primary prevention of myocardial infarction, maintenance of ideal weight, smoking cessation, exercise, use of combined oral contraceptives (OCs) with a low-androgenic progestin, and postmenopausal estrogen replacement. OCs also slow progression of long-term sequelae (e.g., cardiovascular disease).