in the release of adrenal androgens. certain drugs cause hyperandrogenism through mechanisms that remain unclear. for example, the molecular basis by which valproate induces hyperandrogenism and polycystic ovary syndrome has yet to be determined. however, one study showed that women taking valproic acid had higher testosterone levels and incidences of hyperandrogenism compared to women who were not taking valproic acid. heredity hyperandrogenism can appear as a symptom of many different genetic and medical conditions. some of the conditions with hyperandrogenic symptoms, including pcos, may sometimes be hereditary. additionally, it is thought that epigenetics may contribute to the pathogenesis of polycystic ovary syndrome. one potential cause of pcos is maternal hyperandrogenism, whereby hormonal irregularities in the mother can affect the development of the child during gestation, resulting in the passing of polycystic ovary syndrome from mother to child. however, no androgen elevations in were found in the umbilical cord blood of children born to mothers with pcos. diagnosis diagnosing hyperandrogenism can be complex due to the wide variety and severity of signs and symptoms that may present. it is most often diagnosed by checking for signs of hirsutism according to a standardized method that scores the range of excess hair growth. girls may show symptoms of hyperandrogenism early in life, but physicians become more concerned when the patient is in her late teens or older. checking medical history and a physical examination of symptoms are used for an initial diagnosis. patient history assessed includes age at thelarche, adrenarche, and menarche; patterns of menstruation; obesity; reproductive history; and the start and advancement of hyperandrogenism symptoms. patterns of menstruation are examined since irregular patterns may accompany hyperandrogenism. other conditions that may present alongside hirsutism that can contribute to diagnosis include androgenic alopecia and acne. if hyperandrogenism is severe, virilization may occur. family history is also assessed for occurrences of hyperandrogenism symptoms or obesity in other family members. laboratory tests can measure fsh, luteininzing hormone, dheas, prolactin, 17α-hydroxyprogesterone, and total and free testosterone in the blood. abnormally high levels of any of these hormones help in diagnosing hyperandrogenism. prevention since risk factors are not known and vary among individuals with hyperandrogenism, there is no sure method to prevent the condition. accordingly, more long-term studies are needed to find a cause of the condition before a sufficient method of prevention can be established. despite this, there are a few things that can help avoid long-term medical issues related to hyperandrogenism and pcos. getting checked by a medical professional for hyperandrogenism — especially if one has a family history of the condition, irregular periods, or diabetes — can be beneficial. a healthy weight and diet may reduce the chances, as continued exercise and a healthy diet lead to an improved menstrual cycle, decreased insulin levels, and lowered androgen concentrations. treatment there is no definitive treatment for hyperandrogenism as it varies with the underlying condition that causes it. as a hormonal symptom of pcos, menopause, and other endocrine conditions, it is primarily treated as a symptom of these conditions. drugs may be considered only in women who do not plan on becoming pregnant in the near future. some effective drugs for facial hirsutism includes eflornithine, which may cause birth defects in pregnant women. retinoids and antibiotics can be used for acne and minoxidil for alopecia. systemically, it is treated with antiandrogens such as cyproterone acetate, flutamide and spironolactone to reduce androgenic signaling. for hyperandrogenism caused by late-onset congenital adrenal hyperplasia (locah), treatment is primarily focused on providing the patient with glucocorticoids to combat the low cortisol production and the corresponding increase in androgens caused by the increase in size of the adrenal glands. estrogen-based oral contraceptives are used to treat both locah- and pcos-associated hyperandrogenism. these hormonal treatments reduce the androgen excess and suppress adrenal androgen production, bringing about a significant decrease in hirsutism. hyperandrogenism is often managed symptomatically. hirsutism and acne both respond well to the hormonal treatments described above, with 60–100% of patients reporting an improvement in hirsutism. androgenic alopecia however, does not show an improvement with hormonal treatments and requires other treatments, such as hair transplantation. supplementation can also contribute to the managing the symptomatic effects of hyperandrogenism. in a meta-analysis, high-dose vitamin d supplements given to women with vitamin d deficiency due to pcos improved glucose levels, insulin sensitivity, and cholesterol levels, as well as lowering testosterone, sex hormone-binding globulin, and the free androgen index, all of which are associated with hyperandrogenism. vitamin d supplementation in women with vitamin d deficiency but without pcos did not show the same results. targeting insulin resistance and obesity lifestyle modifications are the first-line treatment for pcos. they help improve body composition, insulin resistance, and hyperandrogenism. however, it is unclear whether they help improve mood, quality of life, and reproductive outcomes. a meta-analysis study in 2017 showed that bariatric surgery in women with severe obesity and pcos decreased levels of total and free testosterone and helped correct hirsutism and menstrual dysfunction. insulin resistance in women with pcos is typically treated with insulin-sensitizer drugs such as metformin. metformin can help to decrease weight and androgen levels. when combined with lifestyle modifications (changes in diet and exercise), it has been linked with lower body mass index and a reduction in menstrual problems. however, the use of metformin in women with pcos should only be considered in patients with impaired glucose tolerance. society and culture because androgen excess is manifested in noticeable physical features (such as hirsutism), social stigma may be associated with it. sports main article: world athletics female eligibility regulationscurrent evidence-based studies show that unusually high levels of circulating testosterone are associated with increased athletic performance in women, unless they lack androgen sensitivity. however, controversy has emerged in the form of the claim that testosterone is not unlike any other physical parameter with reference to bestowing advantages or disadvantages on female athletes. existing regulations throughout competitive sports are currently being refined to specifically address this particular claim.caster semenya, a genetically xy female athlete with 5-alpha reductase deficiency. following the case of south african athlete caster semenya, an athlete with a difference in sex development (dsd), the international association of athletics federations introduced its hyperandrogenism regulations, which restricted women with high testosterone levels, whether the hormones were produced by ovaries, adrenals, or testes. these regulations replaced the earlier sex verification rules. following a series of legal challenges, regulations called the eligibility regulations for the female classification (athletes with differences of sexual development) were released on 1 may 2019. these regulations apply only to athletes who have a dsd, high testosterone and virilization, and no longer include hyperandrogenism from non-dsd-related causes such as pcos. such dsds, often seen in people who have a y chromosome and testes, include 5α‐reductase deficiency, partial androgen insensitivity, and congenital adrenal hyperplasia. social definition cultural variation can define hyperandrogenism socially—apart from clinical and chemical definitions—to make some hair growth unacceptable even if it is considered clinically normal based on metrics like the ferriman-gallwey score. for example, only pubic and axillary hair may be tolerated in north american women, while other androgen-dependent hair such as growth on the upper lip, over the linea alba, on the thighs, and around the areola is not. organizations professional organizations such as the androgen excess and pcos society exist to promote the research, treatment, diagnosis, and prevention of such disorders and to educate the public and scientific community about them. interact, an intersex organization, listed hyperandrogenism as an intersex variation in a glossary from 2022.