Androgens in Women: Role in Androgen-Mediated Cutaneous Disorders

The document from 2019 examines the role of androgens in androgen-mediated cutaneous disorders (AMCDs) such as acne, hirsutism, and female pattern hair loss (FPHL) in women. It explains that androgens are produced in various organs and tissues, including the skin, and are essential for the development of these common skin conditions, but their exact role is complex and not fully understood. Dermatologists face challenges in differentiating between physiological and pathological presentations of AMCDs and there is a lack of guidelines for endocrinologic evaluation. The document suggests that serum androgen levels are not always indicative of androgen status, as local tissue levels and sensitivity are more significant in acne pathogenesis. Hirsutism is often associated with elevated serum androgen levels, while FPHL is thought to be due to genetic differences in androgen responsiveness. A comprehensive hormonal workup is recommended for women with multiple AMCDs or signs of virilization or menstrual irregularities, including tests for total testosterone, SHBG, free testosterone, DHEA-S, and beta-human chorionic gonadotropin. A retrospective chart review of 950 women showed that 18.5% had normal androgen levels, and 15.8% with elevated androgens had normal ovulatory cycles and ovaries, termed "idiopathic hyperandrogenism." Women with abnormal androgens should be referred for a comprehensive evaluation, and serum androgen levels above certain thresholds may indicate androgen-secreting tumors.