Hyperandrogenism
Hyperandrogenism is the clinical or biochemical state of excess androgen effect in women, presenting as hirsutism, acne, alopecia, and/or menstrual irregularity. Under the NIH 1990 and AE-PCOS Society criteria, hyperandrogenism is required for a diagnosis of PCOS. It is also one of the three Rotterdam features. The 2023 international evidence-based guideline carries this forward, requiring any two of three criteria for diagnosis.
Biochemical hyperandrogenism is established by elevated free or total testosterone, DHEA-S, or androstenedione above age-specific reference ranges. Source identification is clinically essential: adrenal-origin hyperandrogenism (characterized by elevated DHEA-S and 17-OHP) must be distinguished from ovarian-origin excess (elevated testosterone and androstenedione). Congenital adrenal hyperplasia, particularly non-classic 21-hydroxylase deficiency, mimics PCOS and must be excluded before a PCOS diagnosis is finalized.
In RRM, hyperandrogenism drives a source-directed workup, not a symptom-suppressing prescription. Once adrenal or ovarian origin is identified, RRM clinicians treat the dysfunction directly. They do not mask androgen excess with suppressive oral contraceptives. Correcting the cause, not suppressing the signal, is the RRM standard.
This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.