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Last updated January 15, 2020. 6 minute read

Androgens: how too much or too little affects men and women

Excess androgens can cause significant side effects, including an increased risk of cardiovascular disease in men and unwanted hair growth and male pattern baldness in women. Low androgens can cause decreased sex drive, erectile dysfunction, and fatigue.

Dr Jefferson Chen Md Written by Dr. Jefferson Chen, MD
Reviewed by Dr. Mike Bohl, MD, MPH

The human body relies on massive networks of signals that allow one part of the body to communicate with another in order to grow, change, and thrive. A key messaging system is the use of chemical signals called hormones. Hormones allow your body to regulate blood sugar, control your mood, govern your hunger, and activate your immune system. Let’s take a closer look at an extremely important group of hormones in men called androgens.

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  • Androgens are a group of hormones that include testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA) that act on the androgen receptor.
  • Androgens are thought of as male hormones, but they are also important in women.
  • Excess androgens can cause significant side effects, including an increased risk of cardiovascular disease in men and unwanted hair growth and male pattern baldness in women.
  • Low androgens can cause decreased sex drive, erectile dysfunction, and fatigue.
  • Androgen levels decline with age.

What are androgens?

Androgens are a group of hormones present in the human body that act on a hormone receptor called the androgen receptor. They have a wide range of functions, including helping to create male sexual characteristics. Testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), androstenedione (A4) are among the hormones in this category. Although they are thought of as male sex hormones, androgens are also important in women. For example, testosterone in women is important for maintaining sex drive (libido), bone density, and muscle mass.

The building blocks of androgens are cholesterol, the same molecules that are found in fatty food and clog your arteries. Because of their chemical structure, you may hear androgens be referred to as steroid hormones. Some androgens are made in the adrenal glands, a pair of glands that sit on top of your kidneys. Androgen production also occurs in your testicles.

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What do androgens do?

Androgens have a wide range of effects on the body. We’ll go over a few of the most significant androgens and what roles they play.

  • Testosterone: Testosterone is the major androgen in men. It works to increase libido, erectile function, sperm production, maintain bone density and muscle mass, red blood cell production, growth of facial and body hair, and regulate mood. Men have 20–25 times higher production of testosterone than women (Horstman, 2012).
  • DHT: DHT is another important androgen. It’s made from testosterone by an enzyme called 5-alpha-reductase. In male babies, it helps the penis, scrotum, and prostate to develop. It also plays a role in the voice and hair changes men go through during puberty. Later on in life, DHT, unfortunately, plays a role in male pattern baldness and enlarged prostate, also known as benign prostatic hyperplasia (BPH).
  • Dehydroepiandrosterone (DHEA): DHEA happens to be very popular in supplements, although it hasn’t really been proven to be beneficial (Sirrs, 1999). It’s naturally produced in the body in the adrenal glands. DHEA is a precursor to testosterone; many of its androgen effects happen after it’s turned into A4 or A5 and then testosterone. It also acts on estrogen receptors and has also been found to have effects on the central nervous system. In particular, it appears to have protective and anti-inflammatory properties on the brain (Yilmaz, 2019).
  • Androstenedione (A4): A4 is made from DHEA in the adrenal glands and in the testicles. It’s then made into testosterone. A4 is thought to play roles in aggression and competition in boys (Gray, 2017). A4 is often taken as a supplement for muscle building but hasn’t been shown to improve testosterone levels or boost muscle development (King, 1999). 
  • Androstenediol (A5): A5 is also made from DHEA and is another hormone that gets made into testosterone. It has effects on estrogen receptors as well as androgen receptors. It has been researched as a way to protect against radiation because it can boost blood cell levels (Whitnall, 2000).

What happens if your androgens levels are too high?

In men, androgens levels are rarely too high and when they are, it’s usually because of medications or supplements. Abusing both natural androgens and synthetic androgenic steroids (also called anabolic steroids or androgenic-anabolic steroids) is a common doping technique that athletes around the world use. Testosterone itself can boost muscle strength and size, but other androgens like A4 and DHEA haven’t shown significant benefits (Bhasin, 1996). However, abusing androgens to boost performance is not without its risks. Studies have reported that increasing testosterone above normal levels in men causes aggression and mood symptoms in some men (Pope, 2000). There also reports of young athletes suffering sudden cardiac death after using androgenic steroids (Hausmann, 1998), along with other cardiovascular side effects including increased cholesterol levels (Brown, 2000) and blood cell levels (Stergiopoulos, 2008), which can increase the risk of cardiovascular disease.

Another major side effect of abusing androgens is shrinking your testicles, causing infertility and dropping your body’s ability to make its own testosterone (Rahnema, 2014). Additionally, the breasts become enlarged because excess testosterone is often converted to estradiol, a potent type of estrogen. Studies have shown that over half of men who take androgenic steroids end up experiencing enlarged breasts (de Luis, 2001).

In women, outside of athletic performance enhancement, there are also conditions that cause increased androgens, also called hyperandrogenism. Polycystic ovary syndrome (PCOS) is the most common of these. In this condition, the ovaries produce too much testosterone. This causes excess body hair and facial hair growth (called hirsutism), male pattern hair loss, acne, and it is associated with infertility from a disrupted menstrual cycle and insulin resistance (Lizneva, 2016). Insulin resistance occurs when your muscles, fat, and liver don’t absorb blood sugar as well as they are supposed to, leading to high blood sugar levels. Increased insulin resistance can lead to diabetes.

Learn more about diabetes here.

What happens if your androgen levels are too low?

Levels of testosterone, the main androgen, that are too low can cause decreased sexual desire, erectile dysfunction (including decreased morning erections), fatigue, loss of muscle mass, increased fat gain, anemia, and osteoporosis (weak bones). This is also called “Low T,” androgen deficiency, or hypogonadism, and it can be evaluated with blood tests. Once the diagnosis is confirmed, it is treated with testosterone replacement therapy (TRT).

What happens to your androgen levels as you age?

Aging causes declines in sex hormones in both men and women. In men, testosterone drops over time. One large study from the National Institutes of Health (NIH) reported that low testosterone affected 20% of men in their 60s, 30% of men in their 70s, and 50% of men over 80 (Harman, 2001). There’s a decline in testosterone in women as well—a study in the Journal of Clinical Endocrinology & Metabolism found that the level of testosterone in a 40-year-old woman is around half that in a 20-year-old (Zumoff, 1995). Women also experience a fall in estrogen with aging, losing around 80% of their hormone levels in the first year of menopause (Horstman, 2012). This causes many of the symptoms associated with menopause including hot flashes, vaginal atrophy, and osteoporosis.