Androgens explained simply
A detailed breakdown of testosterone, DHT, DHEA-S, 5-alpha reductase, and why excess androgens trigger acne, hirsutism, and hair loss.
At a Glance: Quick Summary & Key Takeaways
Androgens are essential for female vitality, libido, and bone density. But when production surges or peripheral conversion into DHT spikes, they trigger frustrating physical changes like facial hair growth, scalp thinning, and cystic acne.
- The four key androgens in women are Testosterone, Dihydrotestosterone (DHT), Androstenedione, and DHEA-S.
- Ovarian androgens are primarily stimulated by high LH and insulin; Adrenal androgens (DHEA-S) are driven by ACTH and psychological/physiological stress.
- Dihydrotestosterone (DHT) is 3 to 5 times more potent than testosterone; local 5-alpha reductase enzyme activity in skin and hair follicles dictates symptom severity.
- Natural 5-alpha reductase inhibitors like Spearmint, Saw Palmetto, and Reishi mushroom complement clinical anti-androgens like Spironolactone.
Meet the Androgen Family
Women require androgens for energy, cardiovascular health, mental sharpness, and bone remodeling. However, the balance between production, transport, and peripheral activation is delicate.
• Testosterone: Manufactured 50/50 between the ovaries and adrenal glands, with some created by peripheral conversion. In PMOS, the ovarian share rises sharply.
• Dihydrotestosterone (DHT): The most potent androgen. It is synthesized locally in hair follicles, sebaceous glands, and genital tissue when the enzyme 5-alpha reductase acts upon testosterone.
• DHEA-S (Dehydroepiandrosterone Sulfate): Produced almost exclusively by the adrenal cortex. Elevated DHEA-S points toward an HPA-axis (stress-driven) component rather than purely metabolic drivers.
• Androstenedione: An intermediate steroid hormone synthesized by the ovaries and adrenals that converts into testosterone and estrone.
The Cellular Mechanism of Hirsutism and Hair Thinning
Why does the same hormone cause coarse hair to grow on your chin while simultaneously causing hair on your scalp to shed and miniaturize? The answer lies in tissue-specific androgen receptor genetics.
In facial hair follicles, DHT binds to androgen receptors in the dermal papilla, stimulating hair shaft diameter, pigmentation, and growth cycles—transforming vellus peach fuzz into coarse terminal hair (hirsutism).
Conversely, in genetically sensitive follicles on the crown and temples of the scalp, DHT shortens the anagen (growth) phase and induces follicular miniaturization, causing the hair shaft to grow back thinner, shorter, and more brittle until the follicle becomes dormant.
Clinical Protocol: Recommended vs. What to Avoid
- Test both ovarian androgens (Total & Free Testosterone) and adrenal androgens (DHEA-S) to identify your driver.
- Drink 2 cups of organic spearmint tea daily, which has been shown in clinical trials to exert mild anti-androgenic effects.
- Optimize gut microbiome health; the gut metabolizes and clears excreted estrogen and androgen metabolites.
- Don't pluck coarse facial hair aggressively if prone to folliculitis and post-inflammatory hyperpigmentation; consider medical laser or electrolysis.
- Don't start high-dose biotin without informing your doctor, as biotin severely skews thyroid and hormone lab assays.
When to Consult a Physician or Specialist
While lifestyle and nutritional adjustments are powerful, seek immediate professional medical attention if:
- You notice rapid deepening of the voice or enlargement of the clitoris (clitoromegaly), which requires urgent evaluation to rule out androgen-secreting tumors.
- Hirsutism progresses rapidly over a short multi-month window.
Frequently Asked Questions
Yes. In metabolic PMOS, lowering circulating insulin directly reduces ovarian testosterone synthesis and boosts liver SHBG production. Many women see significant improvements in androgen levels through dietary modification, strength training, and targeted inositol supplementation.
Scientific References & Clinical Guidelines
- AkdoÄŸan, M., et al. (2007). Effect of spearmint teas on androgen levels in women with hirsutism. Phytotherapy Research, 21(5), 444-447.
- Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Reviews, 37(5), 467-520.
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