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Hyperandrogenism: hormonal abnormality in women

Hyperandrogenism is a hormonal abnormality in which women produce too many androgens. This can lead to high testosterone levels. When women have a high testosterone level, this affects various external characteristics. This includes excessive body hair, a lot of muscle development and a clearly visible Adam’s apple. It can also lead to reduced fertility or even infertility. Hyperandrogenism is a hot topic in sports: is it fair for women with much more testosterone to participate in competitions?


  • What is hyperandrogenism?
  • Hyperandrogenism and polycystic ovarian syndrome
  • Other causes
  • Therapy
  • Hyperandrogenism poses a dilemma for sport


What is hyperandrogenism?

Hyperandrogenism involves excessive levels of androgens in the body . Androgens are substances that promote the development and maintenance of male characteristics. This concerns both the development of the male sexual organs and secondary sexual characteristics such as body hair, muscle development and the growth of the Adam’s apple and thus the lowering of the voice. The best-known substance that falls under the androgens is the hormone testosterone, but also include androstenediol and androsterone.When a woman has hyperandrogenism, this leads to masculine appearance such as a masculine physique, little to no breast growth, a lot of body hair and a low voice. There may also be acne, early balding, a high libido and reduced fertility or even infertility.Hypoandrogenism is the opposite of hyperandrogenism. In this condition, too few androgens are produced in the body. In women, this can lead to osteoporosis, loss of libido, fatigue, depression, hot flashes and palpitations.

Hyperandrogenism and polycystic ovarian syndrome

Hyperandrogenism is one of the first symptoms of the condition polycystic ovarian syndrome. Polycystic ovary syndrome is a condition in which multiple cysts are often present in the ovaries. These are caused by a hormonal abnormality. The result of this is that eggs do not grow or grow irregularly and ovulation does not occur or only occasionally. This causes reduced fertility. In women with polycystic ovary syndrome, there is often an excessive production of luteinizing hormone by the pituitary gland, which then stimulates the production of (too many) androgens. Women who suffer from the condition often discover this during puberty because they have irregular periods and suffer excessively from acne or seborrheic eczema. Elevated testosterone levels are measured in approximately 60% of women with polycystic ovarian syndrome.

Other causes

Hyperandrogenism can also have other causes. For example, it can be the result of excessive production of hormones by the ovaries or adrenal glands caused by hyperplasia (abnormal cell growth), a benign tumor (adenoma), a malignant tumor (carcinoma) or SertoliLeydig tumors.


Hyperandrogenism itself cannot be cured, but many of the symptoms can be controlled. For example, medication can be used against acne and thinning of the hair on the head. Hormone blockers can also be used to reduce the effects of testosterone on a woman’s body. Examples of such blockers are finasteride, spironolactone, flutamide and alfatradiol.

Hyperandrogenism poses a dilemma for sport

Hyperandrogenism is a hot topic in sports. Women with too high a testosterone level are in principle not allowed to participate in official competitions against other women because this gives them an unfair advantage. Women with hyperandrogenism generally have more muscle strength, which is a major advantage in many disciplines. Initially, several sports associations set a limit of 10 nmol/L. This was seen as a fairly wide limit as 99% had levels below 3.08 nmol/L. However, a small group of women suffering from hyperandrogenism exceeded this level and were therefore excluded from competition.The best-known example of this is the South African runner Caster Semenya , whose appearance is very masculine. Other athletes suspected of suffering from hyperandrogenism due to their male appearance are Margaret Wambui and Francine Niyonsaba. Indian athlete Dutee Chand was ruled out of the 2014 Commonwealth Games at the last minute after suffering from hyperandrogenism. She took her case to the CAS and won. Excluding women with such conditions or imposing the use of medication would be a violation of human rights. In 2016 it was announced that the IOC would not apply a maximum testosterone level for participation in the Olympic Games. Both Chand and Semenya participated in the Olympic Games in Rio de Janeiro, where Semenya even became Olympic champion in the 800 meters. Semenya is a very well-known person in his own country.

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