At a Glance
Why Get Tested?
To help evaluate adrenal gland function; to detect adrenal tumors or cancers; to help determine the cause of male physical characteristics (virilization) in females or early puberty in boys; to evaluate androgen production and function of ovaries in women or testicular function in men; when congenital adrenal hyperplasia (CAH) is suspected; to monitor treatment for CAH
When To Get Tested?
When a woman has excess facial and body hair (hirsutism), acne, no monthly menstrual periods (amenorrhea), fewer than 6-8 menstrual cycle per year (oligomenorrhea), or infertility; when a boy is undergoing very early (precocious) puberty or a girl is showing signs of virilization; when puberty is delayed; when diagnosing CAH; periodically when being treated for CAH
A blood sample drawn from a vein in your arm
Test Preparation Needed?
In menstruating women, there may be specific instructions as to timing of the sample collection.
What is being tested?
Androstenedione is an androgen, one of several “male” sex hormones that are responsible for the onset of sexual differentiation in males and females and the development of secondary male physical characteristics such as a deep voice and facial hair. Though it is considered to be a “male” sex hormone, it is present in the blood of both men and women and is a precursor that can be converted by the body into more potent androgens, such as testosterone, or converted into the female hormone estrogen. This test measures the amount of androstenedione in the blood.
Androstenedione is produced by the ovaries in women, the testicles in men, and by the adrenal glands in both.
- The pituitary hormone LH stimulates the release of androstenedione by the ovaries and testicles.
- The pituitary hormone adrenocorticotropic hormone (ACTH) stimulates the release of androstenedione by the adrenal glands.
The level of androstenedione in the blood will vary during the day in a “diurnal pattern,” and it will vary during a woman’s menstrual cycle. Because of its origins, androstenedione can be useful as a marker of adrenal gland function, of androgen production, and of the function of the ovaries or testicles. An androstenedione test is often performed after results of other tests, such as testosterone or 17-hydroxyprogesterone, are found to be abnormal.
An excess level of androstenedione and other androgens can cause children to have sex organs that are not clearly male or female (ambiguous external genitalia), excess body hair (hirsutism), and abnormal menstrual periods in girls and precocious (early) puberty in girls and boys.
Adrenal tumors, ACTH-producing tumors, and adrenal hyperplasia can lead to the overproduction of androstenedione. Women with polycystic ovary syndrome (PCOS) may have higher levels of androstenedione as well. While elevated levels may not be noticed in adult men, they can lead to noticeable male physical characteristics (virilization) and a lack of monthly menstrual periods (amenorrhea) in females.
How is it used?
Androstenedione testing is used to evaluate the function of the adrenal gland and the ovaries or the testicles as well as the production of hormones related to the development of male sex organs and physical characteristics (androgens). It is most commonly used to determine the cause of symptoms of excess androgens in a woman who has an elevated testosterone level, along with a few other laboratory tests for this purpose.
An androstenedione level may be used to:
- Evaluate adrenal gland function and to distinguish between androgen-secreting conditions that are caused by the adrenal glands from those that originate in the ovaries or testicles, if results of DHEAS and testosterone testing are abnormal
- Help diagnose tumors in the outer layer (cortex) of the adrenal gland or tumors outside of the adrenal gland that secrete ACTH (ectopic) and separate these conditions from ovarian or testicular tumors and cancers
- Diagnose congenital adrenal hyperplasia (CAH) and monitor CAH treatment, in addition to tests for testosterone and 17-hydroxyprogesterone, for example
- Help diagnose polycystic ovarian syndrome (PCOS) and help rule out other causes of infertility, no monthly menstrual periods (amenorrhea), and excess body and facial hair (hirsutism) in women who have abnormal results on tests for DHEAS, testosterone, and other hormones such as FSH, LH, prolactin, and estrogen
- Investigate and diagnose the cause of male physical characteristics (virilization) in young girls and early (precocious) puberty in young boys
- Help determine the cause of delayed puberty and investigate suspected ovarian or testicular failure
When is it ordered?
Androstenedione may be ordered, along with or following other hormone tests, whenever excess (or, more rarely, deficient) androgen production is suspected and/or when a doctor wants to evaluate a person’s adrenal gland, ovarian, or testicular function.
It may be ordered when a female infant has external sex organs that are not clearly male or female (ambiguous external genitalia) or when a young girl develops male physical features that may be due to CAH or another condition associated with excess androgens.
Androstenedione may be measured when young boys show signs of precocious puberty – the development of an enlarged penis, muscularity, pubic hair, and/or a deeper voice – well before the age of normal puberty. It may also be ordered when puberty is delayed.
It may be measured when a woman has infertility or symptoms that can vary in severity and may include:
- A deeper voice
- Excess facial and/or body hair
- Lack of or irregular menstruation
- Male pattern baldness
Androstenedione is ordered periodically to help monitor glucocorticoid replacement therapy for CAH.
What does the test result mean?
A normal androstenedione level, along with other normal androgen levels and other normal adrenal tests, may indicate that the adrenal gland is functioning normally. However, an androstenedione level may be normal or elevated when an adrenal tumor or cancer is present, depending upon the hormones it is secreting. With polycystic ovarian syndrome, androstenedione may be elevated but may also be normal as this disorder is usually related to ovarian androgen production (primarily testosterone).
An elevated level of androstenedione indicates increased adrenal, ovarian or testicular production. Small fluctuations in concentration are usually normal. An increased level may indicate an adrenal tumor, adrenal cancer, adrenal hyperplasia, or congenital adrenal hyperplasia (CAH). An increased level is not diagnostic of a specific condition; it usually indicates the need for further testing to pinpoint the cause.
A low level of androstenedione may be due to adrenal gland dysfunction, adrenal insufficiency, or to ovarian or testicular failure.
In those with CAH who are being treated with glucocorticoid steroids, normal levels of androstenedione tend to indicate that treatment is effective in suppressing excess androgen production, while elevated levels indicate the need for treatment adjustment.
Is there anything else I should know?
If a radioimmunoassay method is used to measure androstenedione, then a radioactive scan performed within one week prior to testing may invalidate test results.
Androstenedione concentrations increase in boys undergoing puberty, for about two years prior to significant increases in testosterone. Androstenedione levels are not usually used to monitor this process.
Adrenal androstenedione is the major source of androgens for postmenopausal women.
Does everyone with elevated androstenedione have symptoms?
Not necessarily. The type and severity of symptoms will vary from person to person and will vary with age. Adult men have already developed masculine secondary sexual characteristics, so they will not typically experience symptoms with increased androstenedione.
How long will it take for androstenedione test results?
This depends on the laboratory performing the test. It is not a routine test and not all laboratories offer it. Your sample may need to be sent to a reference laboratory for testing. It may take several days for results to be available.
Is this test used for purposes other than detecting problems with the adrenal gland, ovaries or testicles?
Yes, the level of androstenedione (or “andro”) can be done as part of testing for sports doping. Androstenedione is sometimes taken illegally by athletes as a performance-enhancing drug. The body converts it to an anabolic steroid (a synthetic version of testosterone). It is intended to help build muscle, but like other anabolic steroids, it can interfere with bone growth, affect the heart, and in some cases cause liver damage.
Sources Used in Current Review
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Meikle, A. (Updated 2013 January). Congenital Adrenal Hyperplasia – CAH. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/CAH.html?client_ID=LTD. Accessed May 2013.
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