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The adrenal glands produce hormones that help regulate metabolism, blood pressure, and blood sugar levels, among other functions. They also make and release androgens — sex hormones that affect how the body develops. People with congenital adrenal hyperplasia (CAH) make more androgens than is typical, which can cause several symptoms.
In this article, we’ll explain what androgens are and their role in CAH. We’ll also cover how androgen levels affect CAH symptoms and how treatments may help. To learn more about hormones such as androgens, talk to your doctor or endocrinologist (hormone specialist).
Androgens are a type of sex hormone that is primarily thought of as the “male hormone.” According to Cleveland Clinic, males make more androgens than others do. However, everyone makes androgens in the adrenal glands found on top of their kidneys. These glands also make and release cortisol and aldosterone.
Androgens play a key role in many parts of your health, including:
The testicles make and release androgens. The most common androgen is testosterone, which most people know as the hormone that leads to a deep voice and increased body hair during puberty. Testosterone also helps sperm develop.
The ovaries also make and release androgens. However, they make much more of the sex hormone estrogen. Males also make estrogen, but in much lower amounts than testosterone, according to the journal Physiological Reviews.
Androgens can be converted or turned into other hormones. For example, the body uses other chemicals to turn androgens into estradiol. This hormone is the main form of estrogen the body uses for growth and development. Estradiol is important for controlling menstrual periods, keeping bones healthy and strong, and helping with conception and pregnancy.
Although androgens are sometimes called “male” hormones, they’re necessary for everyone. It’s important to keep a healthy hormone balance to avoid complications.
The androgen most people know about is testosterone, but healthy individuals also need several other types of androgens.
When a fetus is growing in the womb, testosterone triggers the development of internal reproductive organs and, in some babies, a penis. During puberty, high testosterone levels lead to genital growth, increased height and bone density, body hair growth, and greater muscle mass.
The ovaries also make testosterone, though most of it gets turned into estradiol. Testosterone can boost libido (sexual desire).
Dihydrotestosterone (DHT) is another androgen primarily found in males, according to Cleveland Clinic. The human body turns around one-tenth of its testosterone into DHT on a daily basis. In males, the conversion occurs in the skin around the genitals and in the prostate and liver. In females, it occurs in the skin or liver.
The exact role of this hormone depends on your age. While a male fetus is developing in the womb, DHT helps form the penis and scrotum. Later, it works alongside testosterone to trigger many physical changes during puberty.
Current research indicates that DHT doesn’t play a significant role in the development of female sexual characteristics. At this time, researchers don’t understand exactly what role DHT plays in females, according to Cleveland Clinic.
Abnormally high DHT levels have been linked to certain conditions, such as:
Your adrenal glands make a specific type of androgen known as dehydroepiandrosterone (DHEA). The body uses DHEA to make estrogen and testosterone. Levels of DHEA peak in puberty and then continue to fall with age.
DHEA sulfate (DHEA-S) plays a key role in puberty and supports reproductive health. This type of androgen helps trigger male sex characteristics, according to MedlinePlus.
CAH develops when the adrenal glands don’t make enough of certain enzymes (proteins) needed for adrenal hormone production. The most common cause of CAH is a genetic change that causes low levels of an enzyme called 21-hydroxylase. This results in 21-hydroxylase deficiency (shortage). However, genetic changes can also affect different enzymes in other types of CAH. As a result, you can’t make enough hormones such as cortisol and aldosterone.
In individuals with CAH, the adrenal glands make extra androgens because they can’t produce enough cortisol, which normally keeps hormone production in balance. The body tries to make more cortisol but ends up making too many androgens instead.
There are two main types of CAH: classic and nonclassic. The type you have depends on how severe your 21-hydroxylase deficiency is. The less of this enzyme you have, the lower your cortisol and the higher your androgen level will be. In the United States, every state offers newborn screening for classic CAH. However, this screening test can miss milder forms of CAH, such as nonclassic CAH. In individuals with nonclassic CAH, symptoms may not appear until later in life.
Classic CAH due to 21-hydroxylase deficiency is divided into two subtypes depending on how severe it is. You may see the terms “salt-wasting” to describe the most severe form and “simple virilizing” to describe the other form.
In both types of classic CAH, the body makes excess androgens. This affects sexual development and leads to symptoms like an enlarged penis in males or atypical genitalia in females, such as a larger clitoris.
Other symptoms of classic CAH caused by excessive androgens include:
People with nonclassic CAH have milder symptoms because their androgen levels aren’t as high. In fact, nonclassic CAH may not be diagnosed until a person reaches adulthood.
In males and females, nonclassic CAH may contribute to symptoms like:
Females with nonclassic CAH usually have typical genital development, but androgen levels are high enough to interfere with certain functions, according to Mayo Clinic. They may experience irregular menstrual cycles and infertility, and they may have a deeper voice or more body hair.
Conditions other than CAH can raise androgen levels in females. Polycystic ovary syndrome is the most common cause of high androgen levels in females. In PCOS, the ovaries make excess androgen hormones. This can cause symptoms like irregular periods, acne, and hirsutism (extra hair growth). With such similar symptoms, PCOS is sometimes confused with nonclassic CAH in females.
Sometimes, people with nonclassic CAH are mistakenly diagnosed with PCOS. Without proper testing, it is easy for doctors to miss the real condition.
Tumors that affect the ovaries or the adrenal glands can also cause raised androgen levels.
If you or your child has CAH, a doctor will develop a treatment plan to control androgen levels. This plan, which may need to change over time, can include medications like glucocorticoids (corticosteroids) and crinecerfont (Crenessity).
Glucocorticoids are a lab-made version of cortisol typically used to treat inflammatory diseases. People with CAH may not make enough cortisol to support healthy bodily functions. Studies show that treatment with glucocorticoids may lower androgen levels to treat CAH. This is especially important in children with CAH so that they can develop during puberty.
It’s important to note that steroid drugs like glucocorticoids aren’t the same as anabolic steroids used by bodybuilders. Our bodies use steroid hormones like testosterone every day.
If you’re pregnant or planning to become pregnant and have CAH, talk to your endocrinologist about adjusting your treatment. Not all cases of CAH require glucocorticoid treatment during pregnancy.
The main way to lower androgen levels in people with CAH is through glucocorticoid therapy. However, healthy lifestyle habits may help support hormone balance, overall health, and the likelihood of becoming pregnant.
In a 2024 review study, researchers found that lifestyle changes such as weight management, regular exercise, and balanced nutrition may improve fertility by supporting ovulation and metabolic health. Diets that place an emphasis on whole grains, plant-based proteins, and healthy fats show promise for managing conditions like PCOS. This study didn’t look at the effect of diet in people with CAH.
Although there hasn’t been research specifically in CAH, some lifestyle strategies may help manage health conditions associated with CAH. Complications like insulin resistance, obesity, high blood pressure, and high cholesterol can worsen symptoms of CAH, including infertility. Additionally, proper nutrition — including getting enough protein, vitamin D, and calcium — can help protect against bone and muscle loss.
Always talk to your healthcare team before making a new lifestyle change or adding a nutritional supplement. Some natural approaches to reducing androgens may help support your overall health. While the idea of foods to reduce androgens may be appealing, no diet change can replace your prescribed treatment plan.
On CAHteam, people share their experiences with congenital adrenal hyperplasia, get advice, and find support from others who understand.
How often do you or your child with CAH receive testing to check your androgen levels? Let others know in the comments below.
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