Hair loss can be a symptom of androgen excess Hazal Ak/Shutterstock

Acne that won’t go away. Hair thinning at the crown. Unwanted facial hair, unpredictable periods, mood swings and weight gain. For millions of women, these aren’t just annoying symptoms – they’re signs of a deeper, often ignored condition: androgen excess. Despite affecting at least one in ten women worldwide, this hormonal imbalance remains underdiagnosed, misunderstood, and too often dismissed.

Androgens are commonly known as “male hormones”, but all women have them too. The problem arises when levels become too high. This excess can wreak havoc across multiple systems in the body, disrupting menstrual cycles, fertility, metabolism and even mental health. Yet because some of the more visible symptoms, like acne or hirsutism, are often brushed off as cosmetic, many women don’t get the support or treatment they need.

The most well known cause of androgen excess is polycystic ovary syndrome (PCOS). It affects up to 13% of women globally and costs the US alone an estimated US$15 billion (£11 bllion) each year.

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But, even though PCOS dominates the conversation, it’s not the only condition behind androgen excess. Other, sometimes more serious, disorders can also cause elevated hormone levels like hormone-secreting tumours, congenital adrenal hyperplasia (a group of genetic disorders that affect your adrenal glands), Cushing’s syndrome (a rare hormonal disorder caused by prolonged exposure to very high levels of the hormone cortisol) and severe insulin resistance. Yet too often, the assumption is that any woman with high androgens has PCOS, which can delay diagnosis of these rarer but potentially serious conditions.

The effects of androgen excess go far beyond skin deep. It’s associated with significant metabolic issues – insulin resistance affects the majority of women with PCOS, putting them at higher risk for type 2 diabetes. Many also live with higher body weight and are more likely to develop high blood pressure, liver disease and cardiovascular problems.

For some, difficulty conceiving is what finally leads them to seek medical help. But even among women not trying to become pregnant, hormonal imbalance can take a toll: anxiety and depression are two to three times more common in women with PCOS than in the general population.

And yet, hormonal health is still too often treated as an afterthought. Many women describe years of feeling dismissed by doctors, told to “come back if you want to get pregnant”, or offered little more than the contraceptive pill. On average, women with PCOS wait over two years and consult several different healthcare professionals before receiving a diagnosis. Nearly half say their symptoms were initially ignored.

Part of the problem may be the name itself. “Polycystic ovary syndrome” is a misnomer – many women with PCOS don’t actually have cysts on their ovaries, and having ovarian cysts doesn’t necessarily mean you have PCOS. It’s a complex metabolic and hormonal disorder, not just a reproductive one. That’s why some experts and patient advocates around the world are calling for a name change to better reflect the condition’s true nature. A more accurate label could raise awareness and improve the way it’s diagnosed and treated.

Encouragingly, there’s been a major step forward in how androgen excess is addressed. In June 2024, the Society for Endocrinology in the UK published new clinical guidelines to help doctors better identify and manage the condition. These guidelines include clear diagnostic pathways, recommendations for when to carry out blood tests or scans, and guidance on when to refer patients for specialist care. Crucially, they acknowledge that androgen excess can affect women at all ages – not just during the reproductive years.

A real difference

Publishing guidelines is only the first step. To make a real difference in women’s lives, several things need to happen. First, there must be greater investment in research. We still don’t fully understand why some women develop excess androgens while others don’t, or why symptoms vary so much between individuals. Research in women’s health has long been underfunded and androgen-related conditions are no exception.

Doctors also need better training. General practitioners, gynaecologists, dermatologists and even mental health professionals all have a role to play in recognising the signs of androgen excess. If they don’t feel confident identifying the symptoms or knowing when to investigate further, women will continue to fall through the cracks.

Just as importantly, women need access to clear, trustworthy information. Too many are left to Google their symptoms or rely on online forums. Knowing what to look out for – and what to ask a doctor – can empower women to advocate for themselves and get the care they deserve.

Finally, we need to move toward more joined up, holistic care. Hormonal health doesn’t exist in a vacuum. It affects – and is affected by – mental wellbeing, lifestyle, metabolism and reproductive health. Effective treatment means looking at the whole picture, not just prescribing a pill or focusing on fertility alone.

Androgen excess may be invisible to those who don’t experience it, but its impact is profound. For too long, it has flown under the radar. With better understanding, better care, and a stronger voice for women’s health, we can ensure that hormonal symptoms are taken seriously – and treated with the urgency and compassion they deserve.

Michael O’Reilly receives research funding from the Health Research Board (Ireland) and Wellcome

Leanne Cussen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.