National consensus on the management of patients with hyperandrogenism (2016)




hyperandrogenism, hirsutism, acne, polycystic ovary syndrome, androgen, a national consensus


Hyperandrogenism is the most common endocrinopathy in women caused by excessive production of androgens by the ovaries and/or adrenal glands or increased local tissue sensitivity to circulating androgens. Frequent characteristic of its manifestations are dermopathy (acne, alopecia, seborrhea and hirsutism), and polycystic ovary syndrome. In addition hyperandrogenism may show impaired reproductive function in women, such as ovulatory disorder, infertility and miscarriage.

Causes of hyperandrogenism are:

• increase synthesis of androgens by the ovaries and/or adrenal glands;

• increased conversion of testosterone into a more active form dihydrotestosterone due to increased 5α-reductase activity;

• reduction of globulin that binds sex steroids;

• increased sensitivity of sebaceous glands receptors and hair follicles to androgens;

• using drugs with androgenic effect.

The severity and allocation of hirsutism determined by the modified scale Gallery-Ferryman, with the estimation of hair growth in 9 body areas that sensitive to androgen, each of which is measured at point scale. To assess the severity of acne is considered the most appropriate combined approach, whereby the determined nature and prevalence of acne items and calculated their number.

A current European standard of laboratory hyperandrogenism diagnosis is evaluation free testosterone by liquid chromatography, but in Ukraine its concentration determines by enzyme immunoassay, which is not sufficiently effective. Also the most informative laboratory parameters in the diagnosis of hyperandrogenism that recommended by the European Endocrine Society includes free testosterone index and androstenedione.

Differential diagnosis involves the exclusion of thyroid diseases, hyperprolactinemia and nonclassical forms of congenital adrenal dysfunction.

Pathogenetic therapy of hyperandrogenism manifestations include:

• dermopathy treatment;

• normalization of hormonal profile and menstrual function;

• protection from endometrial hyperplasia (hyperestrogenemia against the anovulation background);

• reliable contraception when using antiandrogens and systemic retinoids;

• metabolic disorders correction;

• infertility treatment.

Author Biographies

В. В. Камінський, National Medical Academy of Postgraduate Education named after P.L. Shupyk

MD, professor, corresponding member of the NAMS of Ukraine, head of the Obstetrics, Gynecology and Reproductology Department, chief specialist in Obstetrics and Gynecology at the Ministry of Health of Ukraine, executive director of the Association of Obstetricians and Gynecologists of Ukraine

Т. Ф Татарчук, SI “Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

MD, professor, corresponding member of the NAMS of Ukraine, deputy director for research work, сhief of the Endocrine Gynecology Department, chief specialist in Pediatric Gynecology at the Ministry of Health of Ukraine

Ю. О. Дубоссарська, FPE State Establishment “Dnipropetrovsk Medical Academy of Health Ministry of Ukraine”

MD, professor, head of the Obstetrics, Gynecology and Perinatology Department


  1. Goodman, N.F., et al. “Medical guidelines for clinical practice for the diagnosis and treatment of hyperandrogenic disorders.” Endocrine Practice 7.2 (2001): 120–134.
  2. Legro, R.S., Arslanian, S.A., Ehrmann, D.A., et al. “Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.” J Clin Endocrinol Metab 98.12 (2013): 4565–92.
  3. Escobar-Morreale, H.F., Carmina, E., Dewailly, D, et al. “Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society.” Hum Reprod Update 18.2 (2012): 146–70.
  4. Sachdeva, S. “Hirsutism: evaluation and treatment.” Indian J Dermatol 55.1 (2010): 3–7.
  5. Ministry of the Health of Ukraine. Adapted clinical guidelines on acne diagnostics and treatment. Kyiv. Ministry of the Health of Ukraine (2012): 113 p.
  6. Rademaker, M., Garioch, J., Simpson, N. “Acne in schoolchildren: no longer a concern for dermatologists.” Br Med J 298 (1989): 1217–20.
  7. Plunkett, A., Merlin, K., Grill, D., et al. ”The frequency of common non-malignant skin conditions in adults in central Victoria, Australia.” Int J Dermatol 38 (1999): 901–8.
  8. Schäfer, T., Nienhaus, A., et al. “Epidemiology of acne in the general population: the risk of smoking.” Br J Dermatol 145 (2001): 100–4.
  9. Zaenglein, A.L., Pathy, A.L., Schlosser, B.J., et al. “Guidelines of care for the management of acne vulgaris.” J Am Acad Dermatol 74.5 (2016): 945–73.
  10. Dreno, B., Layton, A., Zouboulis, C.C., et al. ”Adult female acne: a new paradigm.” J Eur Dermatol Venereol 27.9 (2013): 1063–70.
  11. Capitanio, B., Sinagra, J.L., Bordignon, V., et al. “Underestimated clinical features of postadolescent acne.” J Am Acad Dermatol 63 (2010): 782–8.
  12. Murashko, N.V., Danilova, L.I. Hyperandrogenism syndrom in women of reproductive age: clinics, differential diagnosis. Training handbook. Minsk (2010).
  13. Iurassich, S., Trotta, C., Palagiano, A., Pace, L. “Correlations between acne and polycystic ovary: A study of 60 cases.” Minerva Gynecol 53.2 (2001): 107–11.
  14. Carmina, E. “The spectrum of androgen excess disorders.” Fertil Steril 85.6 (2006): 1582–5.
  15. The Practice Committee of ASRM. “The evaluation and treatment of androgen excess.” Fertil Steril 86.4 (2006): 241–7.
  16. Kachalina, T.S. “Hyperandrogenism and miscarriage.” Russian Messenger of Obstetrician-Gynecologist 3 (2004).
  17. Fauser, B.C., Tarlatzis, R.W., Rebar, R.S., et al. “Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group.” Fertil Steril 97 (2012): 28–38.e25.
  18. Azziz, R., Sanchez, L.A., Knochenhauer, E.S., et al. “Androgen excess in women: experience with over 1000 consecutive patients.” J Clin Endocrinol Metab 89 (2004): 453–62.
  19. Carmina, E., Rosato, F., Janni, A., et al. “Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism.” J Clin Endocrinol Metab 91 (2006): 2–6.
  20. Azziz, R., Woods, K.S., Reyna, R., et al. “The prevalence and features of the polycystic ovary syndrome in an unselected population.” J Clin Endocrinol Metab 89.6 (2004): 2745–9.
  21. Legro, R.S., et al. “Total testosterone assays in women with polycystic ovary syndrome: precision and correlation with hirsutism.” J Clin Endocrinol Metab 95.12 (2010): 5305–13.
  22. Azziz, R., Carmina, E., Dewailly, D., et al. “The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report.” Fertil Steril 91.2 (2009): 456–88.
  23. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. “Revised 2003 consensus on diagnostic criteria and long-term health risks related to Polycystic Ovary Syndrome (PCOS).” Hum Reprod 19 (2004): 41–7.
  24. Evidence-based Methodology Workshop on Polycystic Ovary Syndrome. Dec 3–5, 2012. Available from: [ pcos/FinalReport.pdf], last accessed Aug 26, 2016.
  25. Dunaif, A. “Insulin resistance in women with polycystic ovary syndrome.” Fertil Steril 86 Suppl 1 (2006): 13–14.
  26. Yavari, M., Khodabandeh, F., Tansaz, M., Rouholamin, S. “A neuropsychiatric complication of oligomenorrhea according to iranian traditional medicine.” Iran J Reprod Med 12.7 (2014): 453–8.
  27. Picardi, A., Lega, I., Tarolla, E. “Suicide risk in skin disorders.” Clin Dermatol 31.1 (2013): 47–56.
  28. Dokras, A., et al. “Increased prevalence of anxiety symptoms in women with polycystic ovary syndrome: systematic review and metaanalysis.” Fertil Steril 97.1 (2012): 225–30.
  29. Dokras, A. “Mood and anxiety disorders in women with PCOS.” Steroids 77.4 (2012): 338–41.
  30. Mastokaros, G., Lambrinoudaki, I., Creatsas, G. “Polycystic Ovary Syndrome in Adolescents. Current and Future Treatment Options.” Pediatric Drugs 8.5 (2006): 311–318.
  31. Warren-Ulanch, J., Arslanian, S. “Treatment of PCOS in adolescence.” Best Practice & Research: Clin Endocrinol Metab 20.2 (2006): 311–330.
  32. Balen, A. “Polycystic ovary syndrome and cancer.” Hum Reprod Update 7 (2001): 522–5.
  33. Fauser, B.C., Tarlatzis, B.C., Rebar, R.W., et al. “Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group.” Fertil Steril 97.1 (2012): 28–38.
  34. Bode, D., et al. “Hirsutism in Women.” Am Fam Physician 85.4 (2012): 373–80.
  35. Abdul-Aziz, A., et al. ”The relationship of body mass index and hirsutism in adult females.” Our Dermatol Online 6.3 (2015): 274–9.
  36. World Health Organization. Global Database on Body Mass Index. BMI classification. Available from: [ jsp?introPage=intro.html], last accessed Aug 26, 2016.
  37. Livadas, S., Diamanti-Kandarakis, E. “Polycystic ovary syndrome: definitions, phenotypes and diagnostic approach.” Front Horm Res 40 (2013): 1–21.
  38. Сonway, G., Dewailly, D., Diamanti-Kandarakis, E., et al. “The polycystic ovary syndrome: a position statement from the European Society of Endocrinology.” Eur J Endocrinol 171.4 (2014): 1–29.
  39. Goodman, N.F., Cobin, R.H., Futterweit, W., et al. “American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome. Part 2.” Endocr Pract 21.12 (2015): 1415–26.
  40. Speiser, P.W., Azziz, R., Baskin, L.S., et al. “Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline.” J Clin Endocrinol Metab 95.9 (2010): 4133–60.
  41. Veltman-Verhulst, S.M., et al. ”Fasting glucose measurement as a potential first step screening for glucose metabolism abnormalities in women with anovulatory polycystic ovary syndrome.” Hum Reprod Oxf Engl 28.8 (2013): 2228–34.
  42. Oxford Handbook of Endocrinology and diabetes. Ed. by I. Wass, K. Owen. The 3d edition. Oxford University Press (2014): 75 p.
  43. Аzziz, R., Carmina, E., Dewailly, D., et al. “Position statement: Criteria for Definition Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline.” J Clin Endocrinol Metab 91.11 (2006): 4237–45.
  44. Ng, D.S. “Diabetic dyslipidemia: from evolving pathophysiological insight to emerging therapeutic targets.” Can J Diabetes 37.5 (2013): 319–26.
  45. Gardner, D.K., et al. Textbook of assisted reproductive techniques, 4-th edition. Vol. 2: Clinical Perspectives. CRC Press (2012): 464 p.
  46. Oettel, M., Carol, W., et al. “19-norprogestin without 17alfa-ethinyl group II: dienogest from a pharmacodynamic point of view.” Drugs of Today 31.7 (1995): 517–36.
  47. Schindler, A.E. “Differential effects of progestins: Europian Progestin Club.“ Maturitas 46.1 (2003): 83–87.
  48. The Practice Committee of ASRM. “The evaluation and treatment of androgen excess.” Fertil Steril 86 Suppl 4 (2006): 241–7.
  49. Krysiak, R., et al. “Update on the management of polycystic ovary syndrome.” Pharmacological Reports 58 (2006): 614–25.
  50. Dronavalli, S., Ehrmann, D. “Pharmacological therapy of Polycystic Ovary Syndrome.” Clin Obstet Gynecol 50.1 (2007): 244–54.
  51. Kahn, J., Gordon, С. ”Polycystic ovary syndrome.” Adolesc Med 10 (1999): 321–36.
  52. Guzick, D., et al. “Polycystic ovary syndrome.” Obstet Gynecol 103 (2004): 181–93.
  53. Plosker, S. “Polycystic ovarian syndrome and insulin resistance.” Med Health RI 86 (2003): 12–15.
  54. Okoroh, E.M., Hooper, W.C., Atrash, H.K., et al. “Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003–2008.” Am J Obstet Gynecol 207.377 (2012): e1–377.
  55. Bitzer, J., Amy, J.-J., Beerthuizen, R., et al. “Statement on combined hormonal contraceptives containing third- or fourth-generation progestogens or cyproterone acetate, and the associated risk of thromboembolism.” Eur J Contr Reprod Health Care 0 (2013): 1–4.
  56. Dinger, J.C., Heinemann, L.A.J., Kuehl-Habich, D. “The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance study on Oral Contraceptives based on 142,475 women-years of observation.” Contraception 75 (2007): 344–54.
  57. Pal, L. Polycystic ovary syndrome: current and emerging concepts. New York. Springer (2014): 340 р.
  58. Eichinger, S., Evers, J.L.H., Glasier, A., et al. “Venous thromboembolism in women: a specific reproductive health risk ESHRE Capri Workshop Group.” Hum Reprod Update 19.5 (2013): 471–82.
  59. Faculty of Sexual & Reproductive Healthcare of the RCOG. UK Medical Eligibility Criteria for Contraceptive Use (UKMEC 2016). Available from: [ pdf], last accessed Aug 26, 2016.
  60. World Health Organization. Medical eligibility criteria for contraceptive use, 5-th ed (2015). Available from: [ am/10665/181468/1/9789241549158_eng.pdf?ua=1], last accessed Aug 26, 2016.
  61. Diane-35 (product monograph). Available from: [ pdf], last accessed Aug 26, 2016.
  62. Shaw, J.C., White, L.E. “Long-term safety of spironolactone in acne: results of an 8-year follow up study.” J Cutan Med Surg 6 (2002): 541–45.
  63. Koltun, W., Lucky, A.W., Thiboutot, D., et al. ”Efficacy and safety of 3 mg drospirenone/20 mcg ethinylestradiol oral contraceptive administered in 24/4 regimen in the treatment of acne vulgaris: a randomized, double-blind, placebo-controlled trial.” Contraception 77 (2008): 249–56.
  64. Koltun, W., Maloney, J.M., Marr, J., Kunz, M. “Treatment of moderate acne vulgaris using a combined oral contraceptive containing ethinylestradiol 20 mkg plus drospirenone 3 mg administered in a 24/4 regimen: a pooled analysis.” Eur J Obstet Gynecol Reprod Biol 155 (2011): 171–5.
  65. Buzney, E., Sheu, J., Buzney, C., Reynolds, R.V. ”Polycystic ovary syndrome: A review for dermatologists: Part II. Treatment.” J Am Acad Dermatol 71.5 (2014): e1–859.
  66. Zouboulis, C.C., Rabe, T. ”Hormonal antiandrogens in acne treatment.“ J Dtsch Dermatol Ges 8.1 (2010): 60–74.
  67. Sudhindra Mohan Bhattacharya, Ayan Jha. ”Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome.” Fertil Steril 98.4 (2012): 1053–9.
  68. Lello, S., Primavera, G., Colonna, L., et al. “Effects of two estroprogestins containing ethynilestradiol 30 microg and drospirenone 3 mg and ethynilestradiol 30 microg and chlormadinone 2 mg on skin and hormonal hyperandrogenic manifestations.“ Gynecol Endocrinol 24.12 (2008): 718–23.
  69. Bargiota, A., Diamanti-Kandarakis, E. “The effects of old, new and emerging medicines on metabolic aberrations in PCOS.” Ther Adv Endocrinol Metab 3.1 (2012): 27–47.
  70. Lopez, L.M., Grimes, D.A., Schulz, K.F. “Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus.” Cochrane Database Sys Rev 4 (2009): CD006133.
  71. Qi, Q., et al. “Association of methylenetetrahydrofolatereductase gene polymorphisms with polycystic ovary syndrome.” Chin J Med Genet 32.3 (2015): 400–4.
  72. Homocysteine Studies Collaboration. “Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis.” JAMA 288.16 (2002): 2015–22.
  73. EUROCAT. European surveillance of congenital anomalies. Available from: [ prevalencetables], last accessed Aug 26, 2016.
  74. Mathur, R., Levin, O., Azziz, R. “Use of ethinylestradiol/drospirenone combination in patients with the polycystic ovary syndrome.” Ther Clin Risk Manag 4.2 (2008): 487–92.
  75. Yildizhan, R., et al. “Comparison of the effects of chlormadinone acetate versus drospirenone containing oral contraceptives on metabolic and hormonal parameters in women with PCOS for a period of two-year follow-up.” Gynecol Endocrinol Off J Int Soc Gynecol Endocrinol 31.5 (2015): 396–400.
  76. Caruso, S., et al. “Hyperandrogenic women treated with a continuous-regimen oral contraceptive.” Eur J Obstet Gynecol Reprod Biol 171.2 (2013): 307–10.
  77. Shestakova, I.G., Ryabinkina, T.P. PCOS: a new look at the problem. The variety of symptoms, differential diagnosis and treatment of PCOS: News bulletin. Ed. by V.E. Radzinskiy. Moscow. Editorial Board of the StatusPraesens Journal (2015): 24 p.



How to Cite

Камінський, В. В., Татарчук, Т. Ф., & Дубоссарська, Ю. О. (2016). National consensus on the management of patients with hyperandrogenism (2016). REPRODUCTIVE ENDOCRINOLOGY, (30), 19–31.



National consensus