The Androgen Precursor Hormone
Androstenedione is a precursor hormone—a building block that gets converted into testosterone and estrogen. It's produced by both the adrenal glands and the ovaries/testes. In women, elevated androstenedione is an important marker for excess androgen production, helping identify PCOS and adrenal hyperplasia.
What is Androstenedione?
Androstenedione is a C19 steroid produced by adrenal zona reticularis and gonads. Converted to testosterone (by 17β-HSD) and estrone (by aromatase). In women, it's a major source of circulating androgens. Peaks in early adulthood and declines with age.
↑ What High Androstenedione Means
Excess androgen production. In women: PCOS, congenital adrenal hyperplasia (CAH), adrenal tumors, ovarian tumors. Causes symptoms like acne, hirsutism, and irregular periods. In men: less diagnostically useful (testosterone is the primary androgen measured).
Common symptoms:
In women: hirsutism (excess body hair), acne, oily skin, hair thinning, irregular periods, infertility
↓ What Low Androstenedione Means
Adrenal insufficiency, ovarian failure, or aging (declines naturally).
Common symptoms:
Fatigue, low libido (adrenal insufficiency)
Why It Matters
When normal:
Identifies androgen source in hyperandrogenism
Key marker in PCOS evaluation
Screens for congenital adrenal hyperplasia (with 17-OHP)
Helps identify adrenal vs ovarian androgen excess
Risks if abnormal:
Elevated: hyperandrogenism, virilization in women
High in late-onset CAH (21-hydroxylase deficiency)
What Can Cause Abnormal Levels?
PCOS
45% likelyOvarian androgen overproduction. Most common cause in premenopausal women.
Congenital Adrenal Hyperplasia
20% likelyEnzyme deficiency (usually 21-hydroxylase) shunts precursors toward androgens.
Adrenal Tumors
Very high levels suggest adrenal tumor.
Ovarian Tumors
Androgen-secreting ovarian tumors (rare).
Cushing Syndrome
Adrenal hyperfunction produces excess androgens.
What You Can Do
If elevated in women: evaluate for PCOS (ultrasound, LH/FSH, testosterone)
Impact: PCOS is the most common cause \u00B7 Timeline: One-time workup
Check 17-hydroxyprogesterone to rule out CAH
Impact: 17-OHP >200 ng/dL suggests late-onset CAH \u00B7 Timeline: AM draw
If lifestyle changes aren't enough:
Lifestyle management for PCOS: weight loss, exercise, metformin
Impact: Reduces androgen levels through improved insulin sensitivity \u00B7 Timeline: 3-6 months
Recommended retest: Per PCOS or CAH monitoring; not routine
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