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When we talk about male and female hormones, we mean sex hormones in a medical sense. However, there is no strict gender-specific separation. Women also form male and vice versa men form female hormones. The different quantity ratio is decisive for the respective effect in the organism. Male hormones are grouped under the term androgens. The main representative of this class of substances is testosterone. There are other hormones that are attributed to androgens. With the exception of androsterone, their biological significance is very low.
Testosterone is made from cholesterol, which is broken down in several intermediate steps. This happens in the testicles and in small amounts in the adrenal cortex, in women also in the ovaries. After production, it gets into the blood and is bound to a transport protein that takes it to its target cells. Testosterone that is not required is broken down in the liver. Androsterone is produced as an intermediate product, which has a similar effect, but in a weaker form. The end products of the breakdown eventually go to the kidneys. There they are filtered out and then excreted in the urine. Testosterone is responsible for numerous functions that define the gender differences.
Functions of testosterone
Testosterone is responsible for the development of the male phenotype (appearance) in prenatal development. It ensures that the penis, scrotum and prostate develop in the male embryo. The next step in development, which is largely determined by the activity of testosterone, is puberty. Here the gender differentiation started in embryonic development continues and is supplemented by further changes. The genital organs grow and reach maturity. The secondary sexual characteristics develop. This includes changing the voice position (broken voice), increasing muscle mass and the development of increased body hair.
The promotion of muscle growth is based on the anabolic effects of testosterone. It increases protein synthesis and provides the muscles with the protein building blocks they need to build them up. Similar processes also play a role in bone metabolism. Testosterone promotes bone length growth, but also ensures that the process is completed early. It initiates processes that close the growth gaps. Overall, testosterone is crucially involved in defining body size.
The third anabolic process that testosterone is involved in is the formation and development of red blood cells (erythropoiesis). The relationships have not yet been scientifically clarified. However, researchers have observed that the combination of testosterone and hypoxia (lack of oxygen) in the blood stimulates the production of erythropoietin. This hormone initiates the formation of new erythrocytes. Increased muscle growth and increased erythropoiesis are processes that are of particular interest to athletes. They are important criteria for increasing performance. Knowing that testosterone can speed up these processes has led to it gaining dubious popularity as a doping agent in sports.
Another important function of testosterone, which begins with puberty, is to promote processes that are very important for reproduction. Its activity causes the sperm to reach maturity during this time. A sufficient level of testosterone is also necessary to increase sexual desire (libido). From a purely biological point of view, it is nothing more than an important driving force for ensuring reproduction. This is also reflected in the fact that testosterone levels in women and thus the desire for sex are highest during the ovulation period.
Animal studies have shown that testosterone administration increases aggressiveness. Some publications describe the transferability of these results to humans. So far, however, there is no scientifically proven basis for this view. The statements are based only on empirical observations that have not yet been systematically classified.
Of course, all the functions described here are based on the assumption that there are no hormonal imbalances. However, certain processes can disrupt the balance of hormones with each other and the release of individual active ingredients. This also includes the excess of testosterone.
Too many male hormones
To be able to assess whether there is an elevated level of testosterone in the blood, it is important to know the standard values. These naturally vary for men and women, but are also different in different phases of life.
Normal values in men
In the following, the unit picogram per milliliter (pg / ml) is used to display the testosterone values. Other parameters are used in some publications. This can lead to confusion among interested people. However, there are now laboratory value visualizers on the Internet that can be used to convert the values into the other value scale. The evaluation of the results should be reserved for a doctor anyway.
The values change very significantly when going through the different phases of life. In a male newborn they are on average between 5.27 and 11.8 pg / ml. Already in the second to seventh week of life the value drops to 4.04 to 8.46 pg / ml. It reached its preliminary low point at the age of seven with less than 0.29 pg / ml. Then it rises continuously up to a maximum of 8.8 to 27.0 pg / ml between the ages of 18 and 39. Then the age-related decline begins, which manifests itself beyond 60 years with an average of 5.6 to 19 pg / ml.
Normal values in women
The testosterone level in women is significantly lower in all phases of life than in men. In babies, it is around 9.74 pg / ml and drops to less than 0.34 pg / ml by the age of seven. From the age of eight, the dynamic of development is the same as for men, but with lower values. The maximum value between the ages of 18 and 39 levels off at 2.57 pg / ml. After that, it sinks again and usually reaches a value below 1.55 pg / ml at an age of over 60 years.
The testosterone levels measured in the blood during the laboratory test are primarily important for medical analysis. In comparison with the normal values, they help to assess whether too much or too little male hormones are active. The blood test is always carried out when there is a suspicion that diseases or other processes in the body negatively affect the testosterone balance. It is an important building block to find the causes of increased or decreased values.
Causes of increased testosterone levels
Androgenital syndrome is a group of hereditary diseases in which hormone synthesis in the adrenal glands is disturbed due to an enzyme deficiency. This mainly affects the hormones cortisol and aldosterone. Their deficiency activates the control centers in the brain, the hypothalamus and the pituitary gland. They stimulate the adrenal gland to compensate for the deficit. As a result, this increasingly produces hormone precursors that cannot be converted into cortisol and aldosterone due to the lack of enzymes. Instead, alternative metabolic pathways are opened that promote the breakdown of hormone precursors to androgens. This can significantly increase testosterone levels. The disease can already be active in embryonic development and in any case influences children's development.
Overproduction of testosterone can also be triggered by tumors on the organs involved in its production. This always happens when the tumor cells are still very similar in function to the host cells. Cancer can affect the testicles in men, the ovaries in women and the adrenals in both sexes. The fundamentally higher synthesis rate of the tumor cells leads to the overproduction of testosterone.
Increased testosterone levels keep popping up in reports about doping. The hormone is one of the anabolic steroids. It promotes muscle building and fat loss. It can also improve endurance performance. These are all parameters that make the prohibited use of the substance interesting for performance-oriented athletes. Accordingly, the market for such businesses is very large. This is also due to the fact that regular and systematic controls only take place in competitive sports. The "normal" fitness and bodybuilding area is largely beyond this control. It forms a gray area in which illegal trade and the use of prohibited substances can flourish in secret.
While doping athletes consciously consume too much testosterone, a lack of female hormones can cause a relative excess of testosterone in women. This can always happen when women stop taking birth control pills. As a result, the hormonal balance gets out of balance. It takes a certain amount of time for the body to adjust to the changed situation, and testosterone gains the upper hand. Some pills also contain substances that suppress the body's testosterone. If this effect disappears, the testosterone-producing organs react with increased activity.
A typical disease in women that is associated with an increase in testosterone levels is polycystic ovarian syndrome (PCOS). It is a complex clinical picture in which the metabolism of the ovaries is massively disrupted by various pathogenic factors. Morphologically, the structural change due to the formation of numerous cysts in the ovaries is in the foreground. Functionally, the complex disturbance of the hormone balance causes an increase in the androgen level.
With adrenogenital syndrome, characteristics of the disease can already be seen in newborn babies in certain forms. This is the case when the hereditary changes have already developed in the embryonic development. Modified external genitalia can be observed in affected girls. Particularly noticeable is the greatly enlarged and almost penis-like clitoris. The inner genitals are normal.
In boys, the external impression of the genital organs is unremarkable except for pigment changes on the scrotum. Unrecognized and untreated, the disease can lead to what is known as premature puberty. Boys develop a greatly enlarged penis while the testicles remain small as children. The growth of body hair begins prematurely in both sexes. Boosted by the increased testosterone, the bones grow faster in length. At the same time, however, the closing of the growth gaps is accelerated, so that the end result is a short stature. Further typical symptoms of an excess of testosterone then appear. This can be acne in both sexes, and girls can also experience poor breast development, cycle disorders and infertility. Symptoms similar to the latter can also cause the tumors on the testosterone-producing organs.
Anabolic steroids used as doping agents in sports can contain natural testosterone. Mostly, however, they are made from synthetic substances that have a similar effect to the body's own hormone. These preparations can cause serious side effects. The typical testosterone acne is still relatively harmless. Cardiovascular problems and liver damage caused by permanent consumption are much more dangerous. The pumping function of the left ventricle can be reduced to such an extent that not only the performance is severely restricted. The risk of dying from heart failure, a stroke or the so-called second death increases enormously. Other side effects may be noticeable as reduced testicles and inability to conceive.
Polycystic ovarian syndrome is a clinical picture in which the effects of too much male hormones can be observed in a very typical form. Of course, this has to do with the fact that only women who increasingly lose their feminine appearance are affected. The signs that an excess of testosterone can result from PCOS include the following changes:
- Reinforcement of body hair through growth and changes in hair structure - the fine and barely visible vellus hair becomes thicker long hair.
- The voice position deepens.
- Testosterone promotes muscle growth and fat loss. This makes the stature more masculine.
- The scalp hair falls out like in balding in men.
- At the same time, the breast shrinks.
- The typical testosterone acne arises from the blockage of the sebaceous glands.
The consequences of an excess of testosterone are often visible and audible. This is especially true when women are affected. For this reason, the doctor can already substantiate the suspicion that too many male hormones are at work through the thorough medical history and the visual findings. The blood test can determine whether there is actually an increased value and how strong the increase is. In adrenogenital syndrome, further hormone parameters are determined (17-hydroxiprogesterone).
Internal organ diseases can be both the cause and the consequence of an increased testosterone level. They can be examined using imaging techniques. Ultrasound examinations on the ovaries at PCOS and liver damage caused by doping can be considered. Magnetic resonance imaging (MRI) can also be used when it comes to classifying changes in the affected organs more precisely.
As part of the diagnosis of cardiac problems, the specific procedures for examining cardiac function come into play. This includes EKG, Doppler sonography and possibly cardiac catheterization. In the case of adrenogenital syndrome, a molecular genetic analysis can be used to determine and confirm the genetic defects. This is possible during pregnancy. The tissue necessary for the examination is either taken from the amniotic fluid or obtained by chorionic villus sampling (chorion = outer pericarp of the fetus). Early detection is very important because therapy can begin in the womb.
As with other diseases, therapy should focus on the causative factors when testosterone levels are elevated. In the case of increased intake by doping athletes, this is quite easy. Those affected should simply refrain from taking the banned substances. As a rule, the testosterone level normalizes and the symptoms recede if no manifest organ damage has yet occurred.
For women who have stopped taking the pill, this is a little more complicated. Simply undoing the withdrawal is usually out of the question because good reasons led to the decision. It is often difficult for laypersons to rebalance the hormone balance on their own. The affected women should definitely consult a gynecologist in order to find a targeted therapy together.
No causal treatment is currently possible for adrenogenital syndrome. The therapy extends to the medicinal addition of the missing hormones. This reduces the production of androgens. The adrenal cortex shrinks and eventually regains its normal size. The hormonal balance is balanced again. Therapy should start as early as possible, ideally in the womb. It has to be constantly monitored because the demand for the hormones supplied in stressful situations is higher and has to be adjusted. With early onset and optimal adjustment of medication, children with the adrenogenital syndrome have a very good prognosis. You can live a normal life. The typical symptoms disappear completely. Affected women achieve normal fertility in adulthood.
In the case of polycystic ovarian syndrome, too, drug hormone therapy is in the foreground. The goal is to suppress the influence of excess androgens and to eliminate the changes caused by them. It is important for many affected women to regain fertility in this way. Since obesity and diabetic changes favor the disease, you can also contribute to your own health by adjusting your diet and exercising regularly.
If the disease cannot be stopped with medication, surgical removal of the affected ovary may also be an option. Surgical therapy may also be necessary for tumors on the testicles or adrenal glands if other procedures such as chemotherapy or radiation therapy have not been successful. It usually consists of removing the affected organ. (fp)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters
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