Your adrenal glands produce hormones that help regulate your 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 normal, which can cause distinct 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).

What Are Androgens?

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:

• Making red blood cells that carry oxygen in your bloodstream
• Building healthy bones and muscles
• Controlling puberty and sexual function

The Role of Androgens

The testicles make and release androgens. The most common androgen is testosterone, which most people know of as the hormone that leads to a deep voice and body hair growth 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 there’s much less when compared with 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 androgen 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 create a pregnancy.

Although most people think of androgens as “male” hormones, they’re necessary for everyone. It’s important to keep a healthy hormone balance to avoid complications.

Although most people think of androgens as “male” hormones, they’re necessary for everyone.

Types of Androgens

The best known androgen is testosterone, but healthy individuals also need several other types of androgens.

Testosterone

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 and sexual desires.

Dihydrotestosterone

Dihydrotestosterone (DHT) is another androgen primarily found in people assigned male at birth, according to Cleveland Clinic. The human body turns around one-tenth of its testosterone into DHT on a daily basis.

The exact role of this hormone depends on how old you are. During development of a fetus, DHT helps form the penis and scrotum. It also works alongside testosterone to trigger many physical changes during puberty. At this time, researchers don’t quite know what role DHT plays in people assigned female at birth, according to Cleveland Clinic.

Abnormally high DHT levels raise the risks of certain conditions, such as:

• Prostate cancer
• Benign prostatic hyperplasia, which causes enlargement of the prostate
• Polycystic ovarian syndrome (PCOS)
• Male pattern hair loss

Dehydroepiandrosterone and Dehydroepiandrosterone Sulfate

Your adrenal glands make a specific type of androgen known as dehydroepiandrosterone (DHEA). The body then uses DHEA to make estrogen and testosterone. Your levels peak in your early to mid-20s and then continue to fall as you age.

DHEA sulfate plays a key role in puberty and supports reproductive health. This type of androgen helps trigger male sex characteristics, according to MedlinePlus.

How Does CAH Affect Androgen Levels?

CAH develops when your adrenal glands don’t make enough of an enzyme known as 21-hydroxylase. Without the right amount, you can’t make the hormones cortisol and aldosterone. Your adrenal glands will also make too much androgen.

CAH develops when your adrenal glands don’t make enough of 21-hydroxylase and instead make too much androgen.

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 higher your androgen levels will be. Every state offers newborn screening for classic CAH, but nonclassic CAH isn’t diagnosed until later in life.

Classic CAH and Androgen Levels

Classic CAH 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 moderate form.

In both types of classic CAH, the body makes too much androgen. This affects sexual development and leads to symptoms like an enlarged penis or ambiguous genitalia, such as a clitoris that’s larger than normal and looks more like a penis. However, the internal sex organs — the ovaries and uterus — usually develop normally.

Other symptoms of classic CAH controlled by androgens include:

• Signs of early puberty, like facial hair and acne
• Facial hair, a deep voice, and larger muscles
• Abnormal menstrual periods
• Benign testicular tumors (noncancerous growths)
• Infertility

Nonclassic CAH and Androgen Levels

People with nonclassic CAH have milder symptoms because their androgen levels aren’t as high. In fact, most cases of nonclassic CAH aren’t diagnosed until a person reaches adulthood.

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 infertility or develop PCOS, which can make it difficult to become pregnant, and have a deeper voice or more body hair.

Anyone with nonclassic CAH may experience symptoms like:

• Early puberty, leading to acne and new body hair growth
• Male pattern baldness
• Fast growth as a child but shorter height at the end of puberty

How Do Doctors Control Androgen Levels in People With CAH?

If you or your child has CAH, a doctor will develop a treatment plan to control androgen levels. This plan can include medications like glucocorticoids (corticosteroids).

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 normally 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 be and have CAH, talk to your endocrinologist about adjusting your treatment. Not all cases of CAH require glucocorticoid treatment during pregnancy.

Talk With Others Who Understand

On CAHteam, the social network for people with congenital adrenal hyperplasia and their loved ones, people come together to gain a new understanding of CAH and share their stories with others who understand life with the condition.

Are you or a loved one living with congenital adrenal hyperplasia? What tests or symptoms led to the diagnosis? Share your experience in the comments below.