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What Is Virilization?

Reviewed by Dan Brennan, MD on April 25, 2021

Virilization is a condition in which females develop male traits such as male pattern baldness or excessive facial hair. It can happen to girls going through puberty and adult women.  It also refers to when a newborn baby, either a boy or a girl, shows symptoms of exposure to male hormones at birth or shortly after birth. 

But virilization can also be voluntary for certain groups of people. Read on to learn more.

Symptoms of Virilization

Symptoms include:

  • A beard or mustache
  • More than usual body hair ( hirsutism)
  • Acne
  • Oily skin
  • Irregular menstruation
  • Male pattern baldness
  • Changes in body fat and muscle distribution
  • Smaller breasts
  • Enlarged clitoris
  • Deeper voice

How pronounced the symptoms are usually depends on the amounts of male hormones, such as testosterone, that are present in the female body.  For example, if you are a woman with low levels of extra testosterone, you may develop a beard and more body hair. If you have higher levels, you may have all symptoms listed. Cases of higher levels of extra testosterone are rarer than ones with lower levels.

Causes of Virilization

The direct cause of virilization is the production of too much male hormone (androgens) in the body. This excess hormone production has many possible causes, including:

  • Use of anabolic steroids, uncommon among women 
  • Medications
  • Tumors that release male hormones (especially on the ovaries or adrenal glands)
  • Polycystic ovary syndrome (PCOS)
  • Congenital adrenal hyperplasia (usually in adolescent girls)

In newborn babies, virilization can result if the pregnant person has any of the above conditions, which can expose the baby to extra male hormone while still in utero.

How Doctors Diagnose Virilization

Doctors start a diagnosis by examining you and taking a medical history. Then they will usually order blood tests to see the levels of androgens in your bloodstream. Such blood tests also help to determine whether the hormones are coming from the adrenal glands or the ovaries.

If further clarification is needed, they may order a CT scan or MRI to view your adrenal glands.

They may also order a dexamethasone suppression test. This test is useful only when the adrenal glands are the cause of the excess hormones. It helps to determine whether the cause is an adrenal adenoma, which is a noncancerous tumor that increases hormone production, or adrenal hyperplasia, which is a genetic disorder of the adrenal glands.

Treatment for Virilization

Doctors can treat many cases of virilization, depending on its cause: 

  • Tumor or adenoma.  Doctors surgically remove tumors from the adrenal glands or ovaries. In many cases, doctors remove the whole adrenal gland that has a growth on it.
  • Polycystic ovary syndrome. There are many available treatments for PCOS:
    • Making healthy lifestyle changes.
    • Taking birth control with estrogen and progestin — you can take it as pills, a patch, or an internal device.
    • Progestin-only therapies that do not prevent pregnancy.
  • Adrenal hyperplasia. Doctors usually prescribe a corticosteroid, like hydrocortisone, to reduce the production of male hormones.

Once your doctor manages to get rid of your excess hormones, most of your symptoms will go away. However, if your voice has deepened, it usually stays that way, no matter the treatment.

Voluntary Virilization

Transmasculine people. Some transmasculine people take male hormones under the care of a doctor with the goal of virilization. They do this so their outward appearance is in line with their gender. This treatment has produced positive effects for transmasculine people.

Continued

Transgender men inject hormones either into the muscle or under the skin. Some people use a gel that soaks into the skin over the course of the day. 

Users of anabolic steroids, usually male weightlifters. People who take male hormones for the purpose of enhancing fitness achieve enhanced virilization along with it. But they also are at risk for:

These risks increase when users do not take steroids under the care of a doctor. 

If you are a male weightlifter using steroids, be aware that they can also give you mood swings and make you more aggressive. And because you inject anabolic steroids with needles, using them may put you at higher risk for contracting HIV and hepatitis.

You may have a hard time giving up anabolic steroids because there are withdrawal symptoms, including:

  • Cravings for the steroids
  • Sleep issues
  • Lower sex drive
  • Feeling restless
  • Lower appetite
  • Depression
  • Suicide

Virilization is a much-needed process for some individuals but can be harmful to others, whether it is accidental or intentional. Be sure to seek a doctor's care when dealing with any aspect of virilization. 

WebMD Medical Reference

Sources

SOURCES:

MAYO CLINIC: "Polycystic ovary syndrome (PCOS)."

MedlinePlus: "Virilization." 

Merck Manual: "Virilization."

Mount Sinai: "Virilization."

NIH National Institute on Drug Abuse: "Anabolic Steroids DrugFacts." 

Translational Andrology and Urology: "Hormone therapy for transgender patients."

UCSF Transgender Care: "Overview of masculinizing hormone therapy."

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