Adrenal gland disorders

Adrenal hyperplasia (enlarged adrenal glands that produce abnormally large amounts of male hormones)

Development of a deepened voice, baldness, an enlarged clitoris, increased muscle size, irregular or absent menstrual periods, and acne, which are signs of virilization

When adrenal hyperplasia is present at birth, external genital organs that are not clearly male or female (ambiguous)

Blood and sometimes urine tests to measure hormone levels

Adrenal tumors (usually cancerous)

Signs of virilization if an adrenal tumor produces excess androgens (like testosterone), or if the person has Cushing syndrome (an adrenal tumor that makes excess cortisol [see below])

MRI or CT

Blood and urine tests to measure hormone levels

Cushing syndrome

Excess fat throughout the torso, a pad of fat between the shoulders (buffalo hump), thin arms and legs, purple stretch marks on the abdomen, easy bruising, a large and round face (moon face), high blood pressure, and diabetes mellitus, acne, absence of menstrual periods or irregular menses

Urine and usually blood tests to measure the level of cortisol (which may be high in Cushing syndrome)

No disorder present

Familial hirsutism

Hirsutism in family members

No other symptoms (normal menstrual cycles and no other signs of virilization)

A doctor’s examination

Blood tests to measure hormone levels (which are normal)

Ovarian disorders

Polycystic ovary syndrome (PCOS)

Hirsutism that begins after puberty

Obesity, infertility, menstrual irregularities, acne, loss of scalp hair, decreased sensitivity to insulin, and darkened and thickened skin in the underarms, on the nape of the neck, and in skinfolds (acanthosis nigricans)

A doctor’s examination

Blood tests to measure levels of hormones, such as testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH)

Usually ultrasonography

Tumors

Sometimes one or more of the following symptoms, which often begin suddenly:

• Pelvic pain

• Abdominal swelling or bloating

• Weight loss

• Signs of virilization

Ultrasonography

Sometimes CT or MRI

Pituitary disorders

A pituitary adenoma (a noncancerous tumor) that secretes prolactin

Production of breast milk in women who are not breastfeeding (galactorrhea)

Irregular or absent menstrual periods

Sometimes vision problems, headaches

Blood tests to measure the level of prolactin

MRI of the brain

A pituitary disorder that causes Cushing disease (such as a pituitary tumor)

See Cushing syndrome, above

Blood and sometimes urine tests to measure the level of cortisol (which may be high)

MRI of the brain

Medications and drugs

Androgenic drugs:

• Anabolic steroids, including those taken to enhance athletic performance, such as testosterone

Signs of virilization

Use of anabolic steroids (sometimes not admitted by the user)

A doctor's examination