Androgens in women: Androgen-mediated skin disease and patient evaluation

J Am Acad Dermatol. 2019 Jun;80(6):1497-1506. doi: 10.1016/j.jaad.2018.08.062. Epub 2018 Oct 10.


Androgens are produced throughout the body in steroid-producing organs, such as the adrenal glands and ovaries, and in other tissues, like the skin. Several androgens are found normally in women, including dehydroepiandrosterone, dehydroepiandrosterone-sulfate, testosterone, dihydrotestosterone, and androstenedione. These androgens are essential in the development of several common cutaneous conditions in women, including acne, hirsutism, and female pattern hair loss (FPHL)-androgen-mediated cutaneous disorders (AMCDs). However, the role of androgens in the pathophysiology of these diseases is complicated and incompletely understood. In the first article in this Continuing Medical Education series, we discuss the role of the skin in androgen production and the impact of androgens on the skin in women. Specifically, we review the necessary but insufficient role that androgens play in the development of acne, hirsutism, and FPHL in women. Dermatologists face the challenge of differentiating physiologic from pathologic presentations of AMCDs in women. There are currently no dermatology guidelines outlining the indications for endocrinologic evaluation in women presenting with acne, hirsutism, or FPHL. We review the available evidence regarding when to consider an endocrinologic workup in women presenting with AMCDs, including the appropriate type and timing of testing.

Keywords: acne; androgen receptor; androgenetic alopecia; androgens; combined oral contraceptive; congenital adrenal hyperplasia; dutasteride; female pattern hair loss; finasteride; flutamide; hirsutism; polycystic ovary syndrome; spironolactone.

Publication types

  • Review

MeSH terms

  • Acne Vulgaris / etiology*
  • Acne Vulgaris / physiopathology
  • Adrenal Gland Neoplasms / metabolism
  • Adrenal Glands / metabolism
  • Alopecia / etiology*
  • Alopecia / physiopathology
  • Androgens / biosynthesis
  • Androgens / blood
  • Androgens / physiology*
  • Cholesterol / metabolism
  • Endocrinology
  • Female
  • Hair Follicle / metabolism
  • Hirsutism / diagnosis
  • Hirsutism / etiology*
  • Hirsutism / physiopathology
  • Humans
  • Menopause
  • Organ Specificity
  • Ovarian Neoplasms / metabolism
  • Receptors, Androgen / metabolism
  • Referral and Consultation
  • Scalp / metabolism
  • Sebaceous Glands / metabolism
  • Skin / metabolism


  • Androgens
  • Receptors, Androgen
  • Cholesterol