Merck Manual

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Ashley B. Grossman

, MD, University of Oxford; Fellow, Green-Templeton College

Reviewed/Revised Feb 2024
Topic Resources

Virilization is the development of exaggerated masculine characteristics, usually in women, often as a result of the adrenal glands overproducing androgens (male sex steroid hormones such as testosterone).

  • Virilization is caused by excess production of androgens usually because of a tumor in or enlargement of an adrenal gland or a tumor in an ovary or abnormal hormone production by the ovaries.

  • Symptoms include excess facial and body hair, baldness, acne, deepening of the voice, increased muscularity, and an increased sex drive.

  • The body changes make it easy for doctors to recognize virilization, and the dexamethasone suppression test can help doctors determine the cause.

  • The adrenal gland that contains the tumor is surgically removed, although sometimes medications can reduce the excess hormone production.

The most common cause of virilization caused by adrenal sex hormones is an

  • Enlargement of the hormone-producing portions of the adrenal cortex (adrenal hyperplasia)

Other causes include

The Adrenal Glands

Symptoms of Virilization

Symptoms depend on the sex and age of the person affected.

Symptoms of virilization include excess facial and body hair (hirsutism), baldness, acne, deepening of the voice, increased muscularity, and an increased sex drive.

In women, the uterus shrinks, the clitoris enlarges, the breasts become smaller, and normal menstruation stops.

In men, the excess adrenal hormones may suppress the function of the testes and cause infertility.

In infant girls with certain types of congenital adrenal hyperplasia Congenital adrenal hyperplasia Birth defects of the genitals can involve the penis, scrotum, or testes (testicles) in boys and the vagina and labia in girls. Sometimes the genitals are ambiguous, that is, not clearly female... read more Congenital adrenal hyperplasia , the genitals may resemble those of infant boys. In children, growth may accelerate. If untreated, the growing centers of the bones (growth plates) may close prematurely and short stature may result. Affected boys may experience premature sexual maturation.

Diagnosis of Virilization

  • Measurement of levels of androgens in the blood

The combination of body changes makes virilization relatively easy for doctors to recognize. Tests can determine the level of androgens in the blood and, if they are high, whether they are likely coming from the sex organs or the adrenal glands.

When the level of adrenal androgens is very high, some doctors use a dexamethasone suppression test to help determine whether the problem is an adenoma or adrenal hyperplasia. If the problem is adrenal hyperplasia, giving the medication dexamethasone prevents the adrenal glands from producing androgens. If the problem is an adrenal adenoma or cancer, dexamethasone reduces androgen production only partially or not at all.

Doctors may do computed tomography (CT) or magnetic resonance imaging (MRI) to obtain a view of the adrenal glands.

Treatment of Virilization

  • Surgical removal of the tumor

  • Sometimes glucocorticoids

Androgen-producing adenomas and adrenal cancers are usually treated by surgically removing the adrenal gland that contains the tumor.

For adrenal hyperplasia, small amounts of corticosteroids, such as hydrocortisone, generally reduce the production of androgens.

Drugs Mentioned In This Article

Generic Name Select Brand Names
A-Hydrocort, Ala-Cort, Ala-Scalp, Alkindi, Anucort-HC, Anumed-HC, Anusol HC, Aquaphor Children's Itch Relief, Aquaphor Itch Relief, Balneol for Her, Caldecort , Cetacort, Colocort , Cortaid, Cortaid Advanced, Cortaid Intensive Therapy, Cortaid Sensitive Skin, CortAlo, Cortef, Cortenema, Corticaine, Corticool, Cortifoam, Cortizone-10, Cortizone-10 Cooling Relief, Cortizone-10 External Itch Relief, Cortizone-10 Intensive Healing, Cortizone-10 Plus, Cortizone-10 Quick Shot, Cortizone-5 , Dermarest Dricort, Dermarest Eczema, Dermarest Itch Relief, Encort, First - Hydrocortisone, Gly-Cort , GRx HiCort, Hemmorex-HC, Hemorrhoidal-HC, Hemril , Hycort, Hydro Skin, Hydrocortisone in Absorbase, Hydrocortone, Hydroskin , Hydroxym, Hytone, Instacort, Lacticare HC, Locoid, Locoid Lipocream, MiCort-HC , Monistat Complete Care Instant Itch Relief Cream, Neosporin Eczema, NuCort , Nutracort, NuZon, Pandel, Penecort, Preparation H Hydrocortisone, Proctocort, Proctocream-HC, Procto-Kit, Procto-Med HC , Procto-Pak, Proctosert HC , Proctosol-HC, Proctozone-HC, Rectacort HC, Rectasol-HC, Rederm, Sarnol-HC, Scalacort, Scalpicin Anti-Itch, Solu-Cortef, Texacort, Tucks HC, Vagisil Anti-Itch, Walgreens Intensive Healing, Westcort
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