Introduction
The development of male features and characteristics in a female is termed virilization. It is an abnormal condition and is often associated with physical and psychological adverse effects on the affected individual. Virilization is also referred to as the normal process occurring in a male’s body during and after puberty. Symptoms include excess facial and body hair, baldness, acne, deepening of the voice, increased muscularity, and an increased sex drive. The most common causes of virilization are; adrenal tumors, anabolic drugs, exposure to excess androgen (male sex hormones) during prenatal development, etc.
What Is Virilization?
When a female develops typical adult male characteristics, the condition is called virilization. The condition is associated with androgen (the primary male sex hormone). It is a condition related to the development of enhanced masculine characteristics in women, primarily due to excess androgens production by the adrenal glands. Androgens are male sex steroid hormones, like testosterone, responsible for developing male features. Both genders produce androgens. The adrenal glands and the testicles in males principally produce androgens. Whereas the adrenal glands mainly produce androgens in females, the ovaries produce a small amount. However, in females, androgens are present in a minimal quantity compared to males. Because of the associated symptoms of the condition, virilization is also often referred to as masculinization.
What Causes Virilization?
The causes of virilization include the following:
-
Excessive androgen or testosterone production. Excess production of androgens causes virilization, which is usually caused by a tumor in or enlargement of the adrenal gland, a tumor in the ovary, or unusual hormone synthesis by the ovaries.
-
Adrenal hyperplasia is the enlargement of the adrenal cortex of the adrenal gland, especially the part responsible for producing hormones.
-
Adenoma of the adrenal gland (hormone-producing tumors).
-
Virilization can also be caused by cancer outside the adrenal gland that produces androgens.
-
Anabolic drugs: The use of androgen pills and injections to increase muscle mass and performance enhancement.
-
A congenital defect that causes an abnormality in the enzyme of the adrenal gland.
-
Virilization can be caused by any medical condition that promotes an imbalance of the sex hormone.
-
In newborns, virilization can occur due to congenital adrenal hyperplasia in the baby or the mother. Additionally, it can develop due to certain medications the mother takes during pregnancy.
-
In girls undergoing puberty, virilization can occur due to PCOS (polycystic ovarian disorder), anabolic drugs, tumors of the ovaries, or adrenal glands (that produce androgens).
-
In adult women, virilization can occur due to steroid drugs and tumors of the ovaries and the adrenal glands.
What Is Prenatal Virilization?
When an excessive amount of androgen is produced by the fetal adrenal glands or an excess of androgen is present in maternal blood, prenatal virilization of a genetically female baby can occur. Intersex disorders and ambiguous genitalia are frequently caused by prenatal virilization of genetic females.
What Is Medically Induced Virilization in Transgenders?
Hormone replacement therapy is sometimes used by transgender people who were medically identified as female at birth. However, this procedure induces virilization by generating many characteristics of normal male puberty. Many of these effects are irreversible, but others can be reversed if the transgender person discontinues or delays medical treatment.
What Are the Signs and Symptoms of Virilization?
The testosterone level in a woman's body determines the signs and symptoms of virilization. Symptoms of virilization also depend on the sex and age of the individual.
Symptoms due to low testosterone levels include:
-
Facial hair growth in the beard and mustache area. The facial hair growth is usually dark and thick.
-
Increased body hair growth.
-
Acne.
-
Oily skin.
-
Oligomenorrhea (Irregular menstrual cycles).
Symptoms due to moderate testosterone levels include:
-
Androgenic alopecia or male pattern baldness.
-
Atypical female fat distribution.
-
Reduction in breast size.
Symptoms due to high testosterone levels include:
-
Clitoromegaly (clitoral enlargement).
-
Muscle growth in male muscle pattern.
-
Deep voice.
-
Shrinking of the uterus.
In men, virilization can cause infertility due to an excess adrenal hormone present in the body. These hormones suppress the normal functioning of the testes.
How Is Virilization Diagnosed?
The diagnosis of virilization is made with the help of detailed medical and family history, thorough clinical and physical evaluation, and several diagnostic tests. These tests include:
-
Blood Examinations: Blood samples are collected and sent to the laboratory to check the levels of several hormones present in the body. The levels of testosterone, estrogen, progesterone, etc., are measured.
-
Dexamethasone Suppression Test: Some clinicians employ a dexamethasone suppression test to assess whether the problem is an adenoma or enlargement of the adrenal glands when the level of adrenal androgens is exceptionally high. Dexamethasone stops the adrenal glands from producing androgens in case of adrenal gland enlargement. Whereas, Dexamethasone decreases androgen production just slightly or not if the problem is an adenoma or cancer.
-
Imaging Tests: Several imaging tests like CT scan (computed tomography) or MRI (magnetic resonance imaging) are done in cases where a tumor is suspected.
How Is Virilization Treated?
Treatment of virilization is done in the following ways:
-
The treatment of virilization depends primarily on the underlying cause of the condition, whether anabolic drugs, tumors, etc, cause it.
-
Surgery is advised in case of a tumor or adenomas. Adrenal cancers and hormone-producing adenomas are usually treated by surgically removing the adrenal gland (containing the tumor).
-
In the case of adrenal gland enlargement (adrenal hyperplasia), Glucocorticoids are used to reduce androgen production. Hydrocortisone is the most commonly used Glucocorticoids in the case of adrenal hyperplasia.
-
Virilization occurring due to anabolic drugs can be reversed by stopping drug intake. However, not all aspects of virilization can be reversed.
What Is Demasculinization?
Demasculinization means the removal of masculine characters and traits. Demasculinization naturally occurs in older men when their testosterone levels drop low in advanced age. In addition, it may occur due to medical conditions like hypogonadism, and it is artificially induced with the help of drugs like antiandrogens drugs, estrogen, etc. With the help of demasculinization, transgender women who have gone through pubertal masculinization attain physical feminine characteristics that might otherwise be hidden or never appear.
Conclusion
The prognosis of virilization treatment is good. The excess amount of androgens present in the body is generally reduced after surgical removal of adrenal tumors or cessation of the anabolic drugs. A female adult may develop virilization due to androgens exposure; many symptoms disappear after the hormones are discontinued. Reversible virilization effects include upper body muscle development, increased sweating, body odor, red blood cell count, etc. Meanwhile, irreversible virilization effects include deepening the voice, facial and body hair growth, clitoral enlargement, balding, shrinking of breasts, etc.
